****PY MEDICAL AID

Good day,

I would like to lodge a formal complaint regarding the handling of my query about my son’s medication following his casualty visit yesterday.

I contacted your team this morning to ask whether the medication prescribed for my son — Tesectan 500 mg, Zofran Zydis 4 mg, multivitamin, Rehidrate, probiotic 500 mg, Buscopan 10 mg, and Panado 500 mg — could be covered by the medical aid, as the pharmacy was closed and I did not have cash to buy the medication. My concern was urgent, as my son had just been seen in casualty and required treatment.

During the conversation, I was informed that because the medication would be obtained from a pharmacy, I would have to pay for it myself, as “the casualty cover on your plan doesn’t fund for this.” I was then told that medication would only be covered if dispensed directly by a KeyCare GP in casualty.

I explained multiple times that casualty departments do not dispense take-home medication, and that they only issue a script. I also stated that there were no GPs available on-site yesterday, meaning it was impossible for the medication to be dispensed by a KeyCare GP as required.

Despite explaining this, I was repeatedly told that the medication is not covered and that “this is how the plan is structured.” No solution, alternative, or escalation was offered — even though my child urgently needed treatment.

In addition to this, I was told that medication could be covered if it is on Discovery’s formulary list, yet when I asked where this list was, I was told it could be emailed — and immediately after that, I was told the medication would not be covered at all. This contradiction is extremely confusing and unhelpful.

I clearly stated that I cannot understand how I am told one thing — that medication will be covered if listed — and now told something completely different. This lack of clarity and inconsistency forced me to consider escalating the matter to external platforms like HelloPeter again, as I am not receiving clear or fair assistance.

I am deeply concerned about the following:

Casualty departments do not dispense TTO medication, yet the medical aid requires this for cover.

When no KeyCare GP is available, members are left without access to essential medication despite having hospital coverage.

The contradictory information regarding the formulary list is unacceptable.

The consultant did not acknowledge the urgency of the situation or provide any meaningful assistance.

The current process effectively leaves a sick child without treatment due to administrative barriers.

I am requesting:

A formal review of this incident.

Clear explanation on what members must do when casualty does not dispense medication and no KeyCare GP is available.

Immediate assistance so that my son’s prescribed medication may be covered or an appropriate alternative provided.

An explanation regarding the formulary list contradiction.

Assurance that members will not be left without essential treatment in similar emergencies.

The current system places members and children at risk, and I am requesting urgent intervention.

Kind regards, Ra’eesah