KH
Kevin H

1 reviews | Active since Jul 2018

12 Jul 2018, 10:20

Discovery's inane decision not to fund a potentially life saving operation

Having been a high level member (classic comprehensive) of this medical aid scheme for many years I was refused funding for a gastric bypass operation earlier this year. This is a Prescribed Medical Benefit but I was forced to pay a total of over R 170 000 out of my own pocket. Upon my application for authority to proceed I was informed of Discovery's decision not to fund the procedure based upon the fact that I had previously undergone similar surgery. I informed them that this was true. I had a gastric band fitted seven years earlier in England. I funded this procedure myself and it ceased performing about 8 months ago, causing me to regress into my previous level of over eating thus causing anxiety and the onset of morbid obesity. I have been reliably informed that failure of the band over a period of time has recently been found to be quite common. I was then informed that the decision was based on their current policy and, in any case, they considered the procedure to be 'cosmetic'. I have submitted detailed written motivations from all specialists involved in the operation, including my GP, to the contrary and am still awaiting response. This situation has forced me to sell my home in RSA and make plans to emigrate to the UK. Be assured that I will be making everyone aware over there that Vitality is the given name of Discovery in England and the level of cover they might expect. I have submitted a copy of my claim to the Ombudsman in hope that they may assist in resolving this situation.

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Replies (2)
Discovery Health
Discovery Health's reply12 Jul 2018, 11:43
Official

Dear Kevin Holden

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply17 Jul 2018, 12:58
Official

Dear Kevin Holden

We have been in touch to answer your comments.

Regards
Discovery Health Servicing Team