Internal documentation and client documentation does not add up. This is *****.

Once again, Discovery doesnt want to pay for PMB's Here follow the list.

1) Went to the Dentist for a filling and Discovery didn't pay. I am on Keycare Plus and I know I am allowed 4 fillings a year. The code was declined by discover, after phoning my dentist and then a manager Penny at Discovery I was told that they don't pay for a filling on the same tooth in a 9 month period. I never knew that? Its not on any of their documentation. It just says rules can apply but this is a new one. Penny told me that the Dentist should have contacted Discovery first to find out if they were allowed to work on my tooth? No I might be slow but if Im sitting in a Dentist chair and half my tooth is gone, should the Dentist contact the Discovery customer care (Which took me 20 minutes to get to a consultant and get approval first? In the 15 minutes I was at the Dentist office? Should they have sent me home with the broken tooth and was I supposed to suffer through the next months until the 9 month period is over? I asked the lady why Discovery doesn't tell their clients about these "rules" and she said that the Dentist have them and they should tell us. I asked the lady but please can I have a copy of that list so that I can have it for future reference. Her answer was that their is no document for clients as the amount of procedures is too vast. I asked her then if the procedures are so vast how are the Dentists then supposed to know? She then told me that they have a 3 page internal document. And I am like, I can read through 3 pages madam, and I believe so can my Dentist. I was told I would get a copy. I am still waiting for the email. I phoned my dentist and they told me that they also know there are rules but they also don't have a set list from discovery, and that if they knew should they then tell the client that he has to leave and only come back when the 9 month period is over? Break the Hypocratic oath and not help a patient by showing them away. I mean the poor dentist must have an archive of knowledge on when and where tooth 14 has been worked on in the past year. I mean out of the 32 teeth in every patients mouth they should keep meticulous records and timeframes. They should know whats going on with tooth 14 before I visit them right?

2) According to Discovery's PMB list my antidepressants are covered on chronic for Bipolar disorder. So I first went to my doctor last year and he app****. It was denied stating that a Psychiatrist must do the application. I went to my Psychiatrist and he filled in all the needed documentation, he even sent a letter of recommendation why. I received a email from discovery that my application was denied because an anti depressant must be prescribed with a Mood stabaliser to be put on chronic. (Once again, nowhere on Discovery documentation is this mentioned). So I asked my Psychiatrist that can he please do an application again and put the mood stabliser on that he has prescribed me. I mean Im following their rules right? I got an email back from Discovery that states they denied it again as that mood stabilizer is not listed under their PMB's. And I told the lady but Im not asking for the mood stabilizer to be put on my chronic medication, he just put it their as that is what they asked for , (a mood stabilizer). I just want them to pay for the antidepressants. I was then told, but that is not really a mood stabilizer its an anticonvulsant and I should go back to my Psychiatrist to get a script for another mood stabilizer (which I have tried all and they didn't work.) So now I am supposed to ask my Psychiatrist to put ask for a different mood stabilizer (Lamotragine she mentioned). But I know it wont work and have tried it. So they expect me to commit ***** to be able to get my medication on chronic. 3) I was told by my doctor that if I were to have minor procedures that I first have to come in for a consultation and then he will give me code that I must personally phone Discovery for approval. I was like but Ive been treated for this previously and according to Discovery, he is my primary doctor so he doesn't need pre approval. I was once again told by the lady that their is a internal list of codes that Discovery has that are approved. I am like well then the doctors should also have it? And shouldn't I then also get it? No people we pay our medical aid every month, their documentation states we are covered but only when they feel like it. We all should be psychic. Maybe the NHI is a good plan. Then discovery and the like will close their doors and we all get free healthcare for everyone.