GP
Gerhard P

1 reviews | Active since Feb 2015

13 Dec 2019, 10:40

Lumbar Facet Injections not payed for.

In Early April I was rendered Immobile due to severe Back pain. I was ambulance to Glynwood Life Hospital and admitted. I spent a few days there and to undergo various scans in order to locate the reason for the back pain. The specialist concluded that I had two compressed vertebrae cushions that lead to one rupturing and touching the nerve.

The surgeon requested further testing in order to acertain the best course of action. I was discharged and issued medication in order to limit the amount of pain experienced.

After receiving the MRI results, the surgeon advised that he would like to first attempt to contain the pain and allow natural healing. This required a Lumba block injection to be administered. I was explained the procedure would be in hospital and required conscious sedation. At this stage I only had minimal movement as the pain was only limited.

The surgeon advised that payment for the procedure would have to be made upfront as he had experienced problems with Discovery. I agreed to this and was scheduled for the procedure.and obtained my pre-authourisation for the hospital.

I underwent the procedure and it was successful.

I claimed the payment to the doctor from discovery and was reimbursed.

Nine moths later I received a call advising me discovery had overpayed me and I need to reimburse them with R2600. I asked which part of the surgeons charges i have to pay back. They rep**** the procedure is payed for, however, the Lumbar facet Block injections are not covered by savings and as my plan has no savings I am liable for the amount. I was advised, had I been operated on (Which would have costed significantly more), they would have covered the cost completely.

I cannot understand how an in-hospital procedure that is required in order to regain mobility is covered, but the injections required for the procedure is not covered.

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Replies (2)
Discovery Health
Discovery Health's reply13 Dec 2019, 12:32
Official
Dear Gerhard P 

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 

Regards, 
Discovery Health Servicing Team. 

Discovery Health
Discovery Health's reply18 Dec 2019, 12:43
Official
Dear Gerhard P 

We have contacted you and discussed your query. 

Regards, 
Discovery Health Servicing Team.