Dissapointing Service

I am very dissapointed and frustrated with Discovery Health. I have been a client since 2017. This year April, we received the good news that we are having a baby. I activated my Maternity benefits immediately in order for everything to be covered accordingly. First I was informed that the plan I am on will not cover the Obgyn so I changed it. Unfortunately due to the time of year they only gave me the optio of Keycare Start. Which I felt was stupid because the plan I was on seemed strong enough to put me on Keycare plus. Which also mean my Chronic illness for Hypertension will not be covered. Well, we proceeded. I then had to also change my income bracket because due to Covid I was retrenched. I had to fo to a Doctor I was not comfortable with to get a reference for a specialist (obgyn) and only then was I able to start my journey with my fiancé. After my first visit with the Gynie 22 June 2020, I was send to pathologists for my first blood test. This all turned out to be necessary because I am 37yr old and Hypertensive. 3 July 2020 my Doctor contacted me to come in for my test results. Sbe explained that an Amnio will be needed because my score is 1:300. So on 6 July 2020 I went back and an amnio was done and sent to the lab. A month later I received my claim and were advised that just under R2000 will be paid and I must cover the bill for R3600 because this will be paid out of the specialist benefit which only covers R2200 for a year. I advised them that Amnios are covered and it is stated in the plan and they said it is a NIPT and without proof it will not be covered. I then got all my test results and it was sent to the NIPT Department. After a lot of back and forth on emails and phone calls I had to make to follow up with Judgement letters from Ampath they confirmed that I was cleared for R6500 and the claim will be covered. In November once again I had to followup because NOTHING has changed. When I called they said the claim connot be processed because ampath used the wrong codes they must adjust and sent a revised invoice to claim. I informed ampath accounts. However an hour later a lady called me from Discovery and advised that this is NOT a NIPT claim, but an Amnio and they will once again sort it out under the right account I must forward them again the statement from Ampath. So I did. I was also informed that when I go for my NIPT I must use my auth number, which I informed her that will NOT BE NECESSARY because my baby will be born in 4 weeks. Well my baby is here and still NOTHING WAS FIXED AND NO FEEDBACK.

Now comes the part where it states that on the plan I must get a referal from a gp to go to the specialist on my Maternity benefit. Which was all well and good. I received 8 consultations with 2 ultra sounds. Which was great. And according to our calculations we will not have to pay for any extra because I will work out perfectly. Turns out, some of the payments are deducted from my specialist benefit which in turn gives me more bills because the benefit has been exhausted. When asked they advised it will be looked into. Once again. NOTHING NOT A WORD.

Then lastly comes the birth of my little peanut. On 7 December we went in for our 2 weekly check up. The Doc checked and confirmed the is happy with my girl however when she checked me confirmed she is going to make my meds more frequent because my bloodpressure is to high. She also said that if it ao happens that I do form some kind of signs of preclampsia she will need to induce labour but will prefer it from week 38 because baby is only 2.7kg. I then explained that I have been throwing up for a week and requested something and maybe if possible something for the pain in my right side thinking it was just bruising from kicks. When she tested it was confirmed that it is my liver and that she is booking me in for induction on 37 weeks. Which was last week. All went well and contractions came however the nurse that was working with me informed me that the baby is in trouble and she was going to phone my doctor. Doc confirmed emergency c-section, which is ONLY allowed by discovery IF necessary or a written motivation. I was pushed into theatre and peanut was born safely. I asked doctor what went wrong and she confirmed the cord was around her face. So as all can see this was needed. However discovery told me I can only be in hospital 2 days and 1 night. But with a c-section I was told to stay anothe night. Which I did because my hospital plan is unlimited... Right....

Now, claims are starting to come. And the first one receiced is from my obgyn for over R8700 which according to benefits advised that it is paid from tbe hospital plan because, hello, authorized codes. But NO! I was informed by discovery that they will not pay for it because my specialist benefit is exhausted.... REALLY?!?! Oh yes! Tried to phone to get help. Was transfered to different departments. Sent an email to claims and complaints, was informed it will take 2 -3 working days!

Above all that before receiving this claim I also spoke to a consultant to change my plan once again to Keycare plus so that I have more cover, that was Tuesday. As per news feeds it must be done before 31 December 2020 to kick in 1 Jan 2021. She said that she will send me document also documents to add my baby. I am STILL waiting.

I cannot just go and change medical aid cause I cannot afford to have a waiting period and on top of that I am not working so relying on spouse support to pay for this.