Emergency bill not paid in full

I am writing to formally lodge a complaint regarding the incorrect processing of a claim for anesthesiology services rendered during my emergency hospitalisation in October.

Background of the Claim: In October, I suffered a miscarriage that resulted in life-threatening complications, requiring an emergency womb evacuation. This procedure was non-voluntary and classified as a medical emergency. Prior to this event, I had successfully activated my Maternity Benefit, which explicitly states that emergency procedures related to pregnancy are covered in full.

The Issue: I have been contacted by the anesthesiologist’s office stating that Discovery Health has only partially paid their bill. This is a direct contradiction of Discovery’s own policy, which stipulates that for a non-network anesthesiologist, the scheme covers the bill in full if the procedure is a non-voluntary emergency. Furthermore, this condition qualifies as a Prescribed Minimum Benefit (PMB). Under the Medical Schemes Act, the scheme is legally required to cover the costs of emergency PMB conditions in full, regardless of whether a network provider was used.

Previous Difficulties: This is not the first time I have had to intervene regarding this specific admission. I previously had to struggle with the scheme to get the hospital bill paid.

I request that Discovery Health immediately re-evaluate this claim and settle the outstanding balance with the anesthesiologist in full. I should not be held liable for a shortfall on a life-saving emergency procedure covered under the Maternity Benefit . I look forward to your urgent response and a confirmation that this bill has been settled.