Not willing to pay for operation

On the 13th of March 2023 I realized that my right knee is tender and sore, and I have difficulty to walk, and my right calf is very swollen and tender and even sore. I have made an appointment with my GP, and he send me for an ultrasound suspecting either a DVT or a Baker’s Cyst. The result of the ultrasound on the 13th of March confirmed that there are no DVT present, but that there are a Ruptured Baker’s Cyst in my right leg which caused the swollen tenderness and pain. I was prescribed Anti-Inflammatory Medicine and for a few days my leg got better, but on the 29th of March, I went back to my GP, and he referred me to a surgeon because the pain and tenderness was back again, and the surgeon again prescribed me with anti-inflammatory medicine. Again, my leg was better after a few days. However, on the 14th of April 2023, I realized that my right calf is all swollen, and that it is very painful and tender, and I have very serious pain when walking. I contacted the Surgeon, and he advised me to go straight to Eugene Marais Radiology for an Ultrasound, because he now suspected that I have a DVT in my right leg. An ultrasound was done, it was confirmed that a DVT (Blood Clot) was formed in the Peroneal Vein in my right leg. I was then rushed to Eugene Marais Hospital Emergency Department and after consulting them, I was admitted to Eugene Marais Hospital, and I got treatment for the DVT until I went home on the 19yh of April 2023. I was prescribed with Warfarin to treat the DVT and I was advised that for 6 months I must use Warfarin and to go for a Blood Test for my INR Count on a weekly basis. However, the pain in my knee persisted and on the 3rd of May 2023, I went back to my GP, and he prescribed me with pain medication for the pain in my knee. On the night of the 3rd of May 2023, I took one of the Pain pills prescribed, and went to bed. I did tell him that I am using Warfarin and that he must give me something which was allowed to be used with Warfarin. On the morning of the 4th of May 2023, I wake up not feeling well, but I went to work as usual. But during the morning of the 4th of May 2023, I became more ill, and my wife was called to take me to my GP. The school nurse tested my Blood Pressure, and it was found to be very high. My GP again send me to Eugene Marais Radiology for an Ultrasound and X-Rays because he was concerned that the DVT (Blood Clot) got loose and travelled through my body to the lungs or heart. An ultrasound was done, and this revealed that the DVT is still located in my right calf, but it was smaller as previously found. Again, I was sent home for some rest, but the pain in my knee and the difficulty in walking, persisted. Since then, I have been in pain constantly, while having huge difficulty in walking and standing. On the 16th of May, I got an appointment with another GP in Pretoria, to get a 2nd opinion on the pain and difficulty in walking. When consulting him, he immediately advised me that he is confident that there is a torn Cartlidge (meniscus) in my right knee. He also asked my if anybody ever send me for an MRI scan of my leg since the 13th of March 2023 when I first went to the GP He also told me that the torn Cartlidge (Meniscus) is most probably the cause of the Baker’s Cyst which probably caused the DVT, and obviously also caused the pain and difficulty when walking. According to various INTERNET Sources, a torn Meniscus can cause a Baker’s Cyst which in turn can cause a DVT. The GP then referred me as an emergency case to a well-known Orthopedic Surgeon in Pretoria for an unscheduled consultation. This was done immediately because of the constant pain I am suffering due to my knee. I did not get any authorization from Discovery for this, because your rules stipulate 2 to 3 days for authorization. This was not a route to follow as the GP advised me not to wait and get treated immediately. The Surgeon suspected that there is a Meniscus tear in my knee, and he sent me to Capital Radiology in Pretoria for an MRI Scan of my leg. The MRI scan revealed that there is indeed a torn Meniscus in my right Knee and to solve this, the Surgeon arrange for an Arthroscopy for the 24th of May 2023 in the Life Groen Kloof Hospital in Pretoria. When contacting Discovery yesterday, I was informed that Discovery does not pay for any surgical procedures of the knee or shoulder, therefor this Arthroscopy cannot be done. It is also mentioned that Life Groen Kloof Hospital is not on your list of Hospitals, but this is something which I think can be solved.

I did lodge a request for review to Discovery, but when talking to a consultant from Discovery, I was told that even if i request a review of the claim, it will immediately be declined because it is not covered by the plan I am on. I am on Keycare Plus and apparently an Arthroscopy is not part of the PMB.

I was also told that I can wait till end of 2023 to change my plan to a higher or better plan which includes an Arthroscopy as a procedure.

Does Discovery really expect me to walk and live in constant pain until I can change plans? I was also told that I must speak to the Surgeon to see if there are other ways to fix the torn Meniscus.

With all the above-mentioned facts in mind, my question to you is the following:

"Why is Discovery willing and able to pay for all the above-mentioned treatments for the Baker’s Cyst, the DVT, the blood tests, the hospitalization, the x-rays, the ultrasounds, and the GP consultations, but you can’t pay or allow me to have an operation to fix the root cause of the Baker’s Cyst and subsequently the forming of the DVT and then Hospitalization?

I think Discovery is only worried about money and that they don't care about human life. They are very quick to take the monthly premium, but thing like this makes me believe that the latter is true.