Don't waste your money! Discovery Health will not help you.

If you were ever thinking of joining Discovery Health at any point in time, let this be a warning of what’s to come. I have been on the Essential Smart Plan for about a year and a half which is supposed to cover me in emergencies and admittance to hospital. People practically had to twist my arm to get a medical aid as it is quite expensive, at least for me that is, but I bit the bullet and joined Discovery. So when I had my first emergency incident ever in my life I expected my medical aid to cover me. Well apparently that could not have been further from the truth. About two weeks ago I suddenly started to pee blood and had pain in my lower abdomen, it was a Saturday so I definitely did not want to wait until Monday to see a GP so being an emergency situation I went to the closest hospital to me which is Hillcrest Private Hospital. They did various tests such as blood tests, urine tests, EKG and blood pressure. I was given an intravenous of antibiotics and fluids to help clear the problem which had now turned into little chunks of blood (apologies for the graphic detail). The doctor at this hospital insisted I be admitted for the night however I knew my cover did not apply to Hillcrest Hospital so they transferred me in an Ambulance to Westville Life Hospital, to stay the night and be checked on the next day by a Urologist assigned to me there, Dr Jansen. By the next day I was feeling better but Dr Jansen had visited me for about 15 seconds to say he wants to do cystoscopy the next day to check what the problem is but before the day was over I was told multiple times by the nurses that Discovery was not going to be covering me for my time in hospital at all, the total now being up to R 10 000 for 1 night and half a day, this doesn't include all the fees from casualty at Hillcrest Hospital. As much as I argued the matter, it didn't matter I had to leave because I was not going to be covered and was not being covered presently. Discovery advised that they might cover me if the cystoscopy came back with a bad result but if it was clean I still wouldn't be covered, so a gamble essentially. Frightened for what I might end up paying if I stayed any longer, I left the hospital with antibiotics Dr Jansen gave me, which might I add, I had to twist his arm to get.

During the week that past I was sent various bills from Discovery for everything they would not cover, including the tests done at casualty in Hillcrest hospital, the doctors fees for Dr Jansen who saw me while I was hospital (Yes you read correctly, they are charging me for the doctor who saw me for 15 seconds while I was admitted to hospital) and the hospital fees for Westville Life, after having fought over email they have yet to confirm whether they are actually covering my stay at hospital which worries me, but as for everything else they have point-blank refused to cover any of it as in their words "not enough clinical information was provided". I gave them everything I had including blood tests, urine tests and the information given to me from Hillcrest Hospital. This is an excerpt from their website “We cover the costs of a casualty visit if you are admitted to hospital from the casualty unit. We pay the costs from your Hospital Benefit, as long as we confirm your admission. Some casualties charge a facility fee, which we do not cover.” Well quite the contrary, they will not cover any of my expenses including admittance to hospital. After the week had passed and my problem persisted, luckily there was no blood but it was still a problem. I went to see my GP who believes it is not a UTI which was everyone's first thought but could be something else or worse. He referred me to a Urologist at Westville Life. I payed for the visit to the specialist who thinks it could be bilharzia but needs to be sure. He wanted to admit me to the hospital in order do a CT scan to make sure there is nothing cancerous or any kidney stones, then if that came back clean he would then perform the cystoscopy which could confirm the bilharzia.

The doctor provided me with documents with his various notes and information and the treatment plan he had in place once I was admitted. I went to get authorization down at reception, after they gave Discovery a call, they asked to speak to me wherein they advised that they WILL NOT COVER ME if I get admitted for this as they need "confirmation of diagnosis" (Can’t tell you how many times that lady said those words to me). In other words they will not cover me unless I do the CT scan first and the scan shows the problem, but if the scan comes back clean they will not cover me. So another gamble it seems. I will only be covered if the scan comes back showing a problem and if it doesn't I will not be covered once again. The whole point of the scan was to allow the doctor to see if there is a concern of cancer or kidney stones and then if not, to do the cystoscopy. So I would need to pay the money to do these tests with the slight chance Discovery might decide to pay me back should it be "severe enough". At this point I would assume its severe enough considering I still have the problem, it seems I need to prove to them that something is actually wrong because I could be doing this all for fun? No matter how much I fought with the women from Discovery on the phone, the answer was a blatant and heartless no, they will refuse to cover this admittance to hospital along with the tests regardless of the fact that a specialist has ordered for my admittance and the fact that this has been an occurring problem I have had for two weeks which started with blood coming out of my private parts, how much more severe do you want.

I as a paying customer should certainly have been treated better, since I pay over R 1000 per month and have never claimed before, should never have been rejected in this instance, nor should NEVER ever have been spoken to in the manner that I was. Let’s look at it this way, If I’ve been paying say, R 1000 per month and not have not claimed once in 18 months that’s R 18 000 (minimum) that has been absorbed into Discovery and basically disappeared into thin air as it not available to me? Now that I need it, after paying for it every single month, have been rejected in an emergency situation? Please explain how such a well - known company is able to get away with this? How does Discovery expect any normal person to be able to afford to pay for these things up front? Answer is, we cant as I am left still untreated. The receptionist at Westville Life even mentioned how many problems Discovery actually give on a daily basis and it goes to show. The only reason they are as big as they are is because they are the greediest. If you truly want to be on the Discovery medical scheme, be prepared to pay for the highest option, because then just maybe you will be treated like a human being.