AK
Angelique K

1 reviews | Active since Apr 2019

28 May 2019, 14:59

DON'T JOIN DISCOVERY MEDICAL AID

If you're reading this post use it as a warning: DO NOT JOIN DISCOVERY MEDICAL AID unless you want to get *****ed over. I do not understand how something that you agree needed to be done for my health is not covered - even partially. I am a stickler for reviewing documents and benefits when I sign policies and nowhere when I signed the policy and read the benefits did it say that vacuum or core biopsies will only be paid from the medical aid if I meet certain criteria, and that the criteria you use to judge that is whether the lump is cancerous or not - and I can guarantee I am not the only person who doesn't know that Discovery is happy to take monthly premiums from their clients but when it comes to something as serious as possible breast cancer they will not pay for a biopsy. As a woman, this is appalling to me and really highlights that Discovery does in fact not care about my health, it's about the profit. You say you are committed to healthcare that is affordable and sustainable yet me having to pay out of pocket for an R9000 procedure to rule out breast cancer says otherwise. The fact that my MSA was used for this shows the value placed on health care - my family now has no access to healthcare for the rest of the year - that's my husband and my 10-month-old daughter as well as myself. The consultant on the phone and the hospital provider made the decision for me - by not informing me that my MSA would be used - my choice and agreement in the matter was simply negated and the decision made for me. You have quite quickly assigned the blame to the provider and have clearly shown you won't be assisting me to ensure that the provider and not myself and my family suffer the consequences of this negligence. So please explain why I should continue to pay you money for myself and my family for healthcare when every action taken by Discovery shows me how little you care about my health? You do not assist your clients and when push comes to shove you won't pay claims and hide behind some criteria you use to evaluate me - criteria that is never made public and cannot be accessed by the public.

All I can say is shame on you Discovery and thank you for showing me your true colors, a national for-profit greedy conglomerate that cares nothing for the people they are meant to provide healthcare for, putting profit over people.

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Replies (3)
Discovery Health
Discovery Health's reply28 May 2019, 15:33
Official
Dear  AngeliqueKlaw 

We’re sorry to hear you’re dissatisfied. Please give us a chance to look into your query and we’ll be in touch soon.

Regards
Discovery Health Servicing Team 
AK
Angelique K's update28 May 2019, 15:36
Reviewer Update
Oh please Discovery - go and investigate I have had the case reviewed 3 times now - including by the executive relationship manager and each time you hide behind the risk criteria - how many people know what that risk criteria is or that in order to have a claim paid for a breast biopsy the lump has to come back as cancerous? Not many I would assume so I will be making sure everyone knows this before considering using your medical aid - it certainly shows how much you value women's healthcare! in your own words" We have a responsibility to make sure members of the Discovery Health Medical Scheme enjoy access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we are able to achieve this is through our plan and benefit design as well as how we create and apply funding policies and clinical protocols. These are developed using a rigorous, evidence-based decision-making process. Using this process helps us decide which procedures and treatments to exclude from cover whilst developing funding policies for procedures and treatments that experts have found to be clinically appropriate and cost-effective." Apparently paying for breast biopsies for suspicious breast lumps is not cost effective for Discovery.
Discovery Health
Discovery Health's reply30 May 2019, 14:53
Official
Dear  AngeliqueKlaw 

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team