Pre-Authorisation frustration

I am truly disappointed in Discovery Health and the various loopholes they hide behind to avoid paying out for valid procedures. My gastroenterologist has instructed me to undergo both a gastroscopy and colonoscopy on 26 July 2019. I have been trying unsuccessfully for two days now to obtain authorisation for these procedures.

The doctor has made it clear that he will only perform these scopes at St Augustines Hospital as that is the hospital at which he practices. He will not carry out these procedures at a day clinic due to the risks involved.

St Augustines is one of my network hospitals hence me choosing a doctor at that hospital. Discovery is now insisting that these procedures can be done at a day clinic and if I want to go through with the booking at St Augustines I will incur a penalty of R8800. The doctor has never and will never carry out either of these at a day clinic. I have been informed by the practice that Discovery regularly declines authorisation despite knowing that the doctor will never do a scope at a day clinic. In addition, the colonoscopy falls under my PMB as I have an existing chronic condition. My PMB specifically indicates that it covers 1 colonoscopy WITH HOSPITAL EQUIPMENT.

Surely this indicates that the colonoscopy should be done in hospital.

This is extremely frustrating for me as a patient as I now have to deal with the stress of my illness plus the hassle of trying to obtain authorisation without incurring such an exorbitant penalty.

I feel this is a very poor respresentation of your health scheme, if this is the way Discovery chooses to treat my first request for hospital authorisation.