Dishonest Discovery Health

Forced to R7,950.00 co-payment when actual hospital expenditure was only R755.00. My health plan does not cover an Arthroscopy, if it is done in theatre, instead of in the doctors room’s. In the scenario where it is done in theatre, the member must make a co-payment of R7,950.00. After an accident, I was scheduled for an operation in theatre to reconstruct 2 torn ligaments and my meniscus. All this was covered and authorisation was given by the medical aid without any co-payments. The plan was that the Arthroscopy and reconstruction of the ACL would be done in 6 months’ time. During surgery in theatre the surgeon found that it would be possible to also do the Arthroscopy and reconstruction of the ACL. Discovery changed their original authorisation and notified me a week later that I would be responsible for the co-payment of R7,950.00. The itemised billing from the hospital has the costs of the Arthroscopy at R755,00 of the total bill of R141k. I have written to the Discovery medical review board with motivations from the surgeon, CTI scans etc. to prove that I had to undergo surgery in any event and that the Arthroscopy was only a small part of the procedure. I also said that I would cover the actual cost of R755,00 but to no avail. I now have to pay R7,950.00 to prevent the hospital from taking legal action against me when the actual costs for the matter they do not cover on my plan is R755.00.