My emergency was not seen as an emergency according to the claims

This is a message to Discovery South Africa

I’ve been a Discovery Medical Aid member since 2015. I’ve always been happy with the level of service i received, but not this time. I am utterly disappointed in Discovery and lost all my satisfaction and appreciation for them.

On the 18th of April, at 18:30 pm, i had an accident at home while making food, where I cut myself open with a tuna can on my hand. The cut was deep and it was bleeding heavily. I knew i needed stitches. My husband drove me to Life Eugene Marais Hospital as this is our closest Network Hospital. I had a towel wrapped around my hand for the bleeding. As i arrived at the hospital, the receptionist asked what happened. I told her the story. I did not even sit down and waited for someone to help me. She assisted me immediately. She saw that the blood was still dripping down on my arm and she asked my id card, medical aid details and I signed the form, she said i must go through so someone can help me. I got stitches, tet**** shot etc.

A week later, i received an email that the medical aid only covers R95 of the “casualty visit” and that i need to pay the first R475.

Now my argument is this: According to me, it was definitely a medical emergency. The dr’s are closed that time of night, i couldn’t wait untill the next morning. So I went to hospital. Even the receptionist handled it as an emergency. I thought to myself, no maybe the receptionist used the wrong code when submitting it, i’m not sure. I phoned Discovery this morning to confirm and make sure and the lady stated that it was indeed not a medical emergency and that i am liable to pay that money. And i asked her but why is that not being seen as a medical emergency? And when will it then be seen in that way? Because i even checked the healthplan guide to make sure. She said, the ONLY time an incident will be seen as a medical emergency is if you are unstable and unconscious when entering the ER. I think this is absolutely ridiculous. Because where is that peace of mind to go to the ER if something unplanned, happens? Where am i supposed to go at 18:30 pm for a cut that deep? This just does not make sense to me at all. I am very unhappy about this situation. She said there’s even no way to ask Discovery to review the claim. Just to give another piece of background: i was supposed to go back there in 2 days for a follow up. Which i did not, because i know they charge a ridiculous consultation fee. Which i don’t have. That’s why I went to my normal GP for the checkup. As well as 10 days after that to my normal GP for the stitches to be removed. If i had money for all the co-payments i would obviously be on a better plan.

This is unacceptable that this situation was handled as a non-emergency claim.