Never a happy ending

<p>Needless to say, as the title suggests, I've been with Discovery for just over 3 and a half years and not once did I have a good experience. Barely even satisfactory. two years ago I was slapped with a R3000 copayment after visiting the ER, the single one time I needed them for that whole year!! I am left so frustrated that I am fighting with my company to take me off the scheme completely but they insist it's compulsory. I'd rather take my money somewhere else.</p> <p> </p> <p>This time around it's no better. My wife and I had our baby on the 2nd Feb 2017. The birth was pre-autorised and approved based on the procedural codes we received from our gynaecologist. I called discovery to inform them that the gynae is suggesting an early induced labour (about two weeks earlier than the due date) due to a complication my wife has been having. They requested the procedural codes and approved it within minutes. Thinking that everything is fine and in order, we started preparing for the day we need to go into hospital. All was fine until just 5mins before the birth when the midwife called the doctor to inform him that baby will be here any minute. at the time it was just the midwife and gynaecologist present. When another doctor arrived (the paedeatrician whom the midwife had called minutes earlier), that's when the worry started. Who is this guy and why was I not informed that he'll be part of the procedure? He then does his checks with baby, snips the umbelical cord and off he goes again. A few days later he bills me as discovery had paid him short. According to discovery, our gynae should've informed us that the paed will be part of the team. I was clearly not informed. Now, when seeing this guy for the first time as my wife was giving birth, was I supposed to ask who he is and how he is covered or whether he falls within the discovery network? Or should I be there supporting my wife and trust that everything else is in order? At no point was I informed of who else would be on board delivering our baby. I was only aware of the gynae and the midwife. It's like literally being in an accident but you have to ensure that you are consious to ensure whoever is stabilising is within the network. You go to a network hospital but 90% of the practicioners there are not within the network. We've had a similar experience 2 years ago when my wife miscarried over the easter weekend while discovery was unreachable, we rushed to the ER, they admiited my wife, the next morning we were treated by a gynae that wasn't in the network? should we then have refused his help while our baby was busy dying?! I can't deal with discovery any longer.</p> <p> </p> <p>To make matters worse, during a gynae visit, he asked if we'd like to opt for an epidural to which we said we are not sure at this point. He then said it's fine, we could decide at hospital when we start the induction. prior to admission, my wife and i discussed it and decided to go with the epidural. I then contacted discovery to enquire about authorisation for it. i was then told to check with our gynae. When I called the Gynaecologist's practice, his secretary told us that the only codes we need were the procedural codes given for the birth. On the evening that we were required to checkin at the hospital, we were introduced to the Nurse on duty. I asked them about how the epidural is covered and according to the nurse, you can never pre-empt how the labour will be going and if an epidural is needed, it will be covered from the hospital cover. Again, this was covered but I was still slapped with a R1500 copayment i'm being billed for now. To what extent should I go to ensure that practitioners are fully covered and are within the network? during severe labour pain, an anaethetist comes and does the epidural, should I stop him and ask for his details and have it pre-approved first? This was a preplanned procedure, with ample time to prepare for, why was I not informed of who will be on board throughout the labour and delivery??</p> <p> </p> <p>This is the process to follow according to discovery's email sent to me when approving the pre-authorisation:</p> <p> </p> <p>It is important to notify us of your pregnancy as soon as you are 12 weeks pregnant so that you always</p> <p>know how we cover you for your pregnancy-related healthcare services, whether these are received in or</p> <p>out of hospital.</p> <p>You can call us on ***or visit www.discovery.co.za to find out how you are covered and to</p> <p>authorise your hospital admission. When you do, remember to have the following information at hand:</p> <p> Date of the admission</p> <p> Name or practice number of the hospital or clinic</p> <p> Name and practice number of the treating doctors and anaesthetist (if available)</p> <p> ICD-10 code from your treating doctor (this is an alphanumerical code that describes your</p> <p>diagnosis (pregnancy), for example O82.0)</p> <p> RPL code from your treating doctor (this is a procedure code that describes how you plan to</p> <p>deliver your baby, for example 2615).</p> <p> </p> <p>This line right here: Name and practice number of the treating doctors and anaesthetist (if available)</p> <p> </p> <p>It clearly says IF AVAILABLE. It was not available because I was not informed of who will be on board. If this matter is not resolved and I keep being harrassed by these practicioners then I will refer the matter to my legal insurance as a claim dispute. I cannot possibly be billed by people I did not appoint or was not made aware of by Discovery, the gynaecologist or the Hospital.</p>