Nightmare of medical aid

After being with discovery health for 9 years, I am highly disappointed with the way they handled my matter. My son was injured, mouth cut opened after a rugby match, bleeding in my back seat, I had to seek urgent medical attention and headed to the nearest dentist who assisted in stitching him up.

On my way to the doctor, I made a call to Discovery to obtain authorization, held for the first 15 minutes, got transferred, after the call and waited again for 10 minutes and more to be told that I should make contact with the Dentist Risk Management because the nearest doctor that I was directed to was a dentist. I refused to make the call because I am not the one subcontracted to the Dentist Risk Management, and the consultant rephrased and advised me that at the dentist they will know which number to dial.

I got to the doctor and upon opening of the file, the contract indicated that they are a cash practice, for my son, I would not turn away and look for another emergency consulting rooms, in the Discovery Health Network, I had to make that payment.

Upon claiming at discovery, the claim was rejected on merits that the doctor was not on their network. 1. How long must one travel to get to the nearest network doctor in an emergency? 2. In a state of mind that I was in, after being frustrated in holding on for the discovery to answer calls, and this is my son that is injured, not discovery's child, I had to make a decision to have him attended to.

Now my claim will not be paid.

I followed the discovery complaint procedure: 1. Sent first mail expressing my disappointment of the claim being rejected. I received a call from Discovery, the gentleman told me that I should perhaps ask the doctor to draft a letter explaining the condition and the treatment given to my son, and maybe the claim might be reviewed. I also explained the fact that I made a call first before, on my way to the directed doctor and suggested that he listens to the telephone conversation. I therefore sent the letter, a day later, I received an email from Dentist Risk Management, just stipulating that the claim will not be paid because the I used the dentist that is not in their network provider. We went through that network stage already, why should I be receiving an email stipulating the same? Why am I not receiving a call? I returned mail and advised that I did not accept the email and its contents. The email clearly indicates the lack of interest and investigation done by them, all they know is that the name of the doctor is not on their network. My emergency did not matter to any one that responded to my emails. 2. I went to the website again, and went through the second step of complaints, mentioned the same concern regarding my claim and I received another email still rejecting the claim because the doctor used was not on their network. I again responded to the email, rejecting the email and its contents because clearly no one cares about the state of emergency, state of mind when it is your child that is bleeding and in pain.

I received feedback, a call this time, and I was told the same Network issue and that the emergency was not life threatening. REALLY! very insensitive, not considering the fact that I was traumatized by the fact that for the first time I had to deal with such an open wound, the bleeding, the cries of an injured child. Noone from discovery really and actually cares, no courtesy at all. I should just be strong it will all pass. Well, it is actually not my first time being on the receiving end of bad service from Discovery, for many procedures that I would either by myself or my children I would have to fight to have claims by discovery. The nightmare never ends with them but now I am never going to deal with such. Discovery should expect my cancellation.