My Claim not being Reviewed from Dr Dale Peterson

To whom it may concern

My Name is Anthony Maart Id #***, Membership No ***, I am the Main member of the discovery Key Care Plus Plan. I am writing to you to review an emergency procedure that was performed by Dr Dale Peterson who is not on our Network.

It all began when my wife went to our Primary Dr (Dr S Dalvie) on the I stand under correction the 21 May 2025 because she was itching all over and she was busy turning yellow. He then sent her for bloods. He received the results and found that there was an anomaly in the blood results and then referred her to Tokai Melomed where she was then booked in on the 23rd of May 2025 and was seen to by the Specialist Physician Dr Moodley. Tests and scans were done, and it was discovered that she had a tumor on her pancreas and this tumor was obstructing the bile duct and it was also found that she had legions in her Colon. With the results she needed to consult a specialist which she then did, and the problem was he is not on our network (Dr Dale Peterson). After seeing the scans, he saw it necessary to do a colonoscopy because of the legions and he also found a specialist who was willing to do a Whipple resectioning on my wife. At that moment it was an emergency because she was then transferred to Gatesville Melomed where she had the operation done and she’s recovering nicely.

The Reason for this complaint is that we are not in control of who the physician referred us to at that present moment and what emergency procedure needs to be done. When Dr here you have medical aid then they charge you double of what the procedure costs. We have the benefit where we covered up to 100% in hospital. I am sitting with a bill of about 16000 that discovery doesn’t what to pay because of what should have been billed.

I wanted Gap cover with discovery, and they denied me because of the plan that I have. Why should I apply for gap cover with another institute where I wanted them to administer the medical aid and gap cover because it will be so much easier because they have all the information already.

I am pleading with discovery to review the case because what happens I hospital most times is out of our control and then we slapped with the repercussions of our medical aid not paying the bill.