Misleading information given by Discovery Health

My KeyCare GP (in-network) referred me to a Specialist. I then get a long sms from Discovery to say that the visit to the Specialist has been approved, that it will be paid from the Specialist Benefit, they gave me a reference number and tell me to book the appointment.

I visit the Specialist, only to be told that they cannot assist me further (not part of KeyCare)!

That took me back to square one. Further expense incurred by myself!!

Discovery reimbursed me R608-20, of the R1,400-00 that I paid.

My issues stems from the misleading information on Discovery’s sms - giving me only one side of the coin. They did not inform me of the critical issues of out-of-network, possible co-payment, or even refer me to an e-mail which they sent.

Which leads me to the second issue: Why does Discovery use two different communication methods (sms and e-mail), one for each side of the coin, when there is no cross-referencing between the two methods, meaning the sms does not refer me to an e-mail, for what turns out to contain critical information.

Based on the sms that they sent, I had all the information I required to proceed with the APPROVED visit.

Had the sms mentioned a co-payment / out-of-network, I would not have visited this particular Specialist.

Hence, I request that the balance (R791-80) is reimbursed to me, which get's deducted from the remaining Specialist Benefit limit.