1 reviews | Active since Apr 2015
Hospital cover denied based on discretion
My mother-in-law was admitted to hospital with severe back pain. 6 days later she was discharged due to the medical aid's 'discretionary limit ' She was admitted again on the same day with severe pain. After further scans it has been established that she needs a major operation to fix a pinched nerve. <br> <br> Discovery Comprehensive Classic plan provides 'unlimited hospital cover'. However, Discovery made a discretionary decision not to pay more than 6 days of cover - the reason given:conservative management of back pain.<br> <br> Undergoing major surgery to fix the issue means that my mother-in-law will have to close her business and lose her income for 2-3 months. However, Discovery thinks that the doctors are being 'conservative' in their treatment to have admitted her in hospital for a second time which lead to this major surgery diagnoses. <br> <br> Discovery members - you might think that you are covered for a medical trauma and hospitalisation but note that the 'unlimited hospital cover' it is still up to the discretion of Discovery individuals who will decide if they think the hospitalization is appropriate despite the diagnoses of various medical specialists at the hospital.
Thank you for your comment.
Due to the Confidentiality Act, the Scheme is unable to provide you with any information on the membership unless we receive written confirmation from the policy holder.
We contacted the treating doctor with feedback and confirm that the funding decision is in line with the Scheme rules. Further communication is being made with the principal members daughter in this regard. We base funding decisions on the information provided, the members chosen plan type and according to the Scheme rules.
Thank you for allowing us to assist your query.
Kind regards
Jashvir
Thank you for your comment.
Due to the Confidentiality Act, the Scheme is unable to provide you with any information on the membership unless we receive written confirmation from the policy holder.
We contacted the treating doctor with feedback and confirm that the funding decision is in line with the Scheme rules. Further communication is being made with the principal members daughter in this regard. We base funding decisions on the information provided, the members chosen plan type and according to the Scheme rules.
Thank you for allowing us to assist your query.
Kind regards
Jashvir
