Really Discovery????

Dear Discovery Medical Aid This is an urgent cry for help!!!

Just a little bit of background. My boy (2yrs 9months) are constantly extremely sick with severe tonsillitis and Otitis media. At only 6 weeks old he had his first diagnosis of Otitis media and his first course of antibiotics. ONLY 6 weeks old!!!!He has been on 10 cycles of antibiotics in the past year alone.

His right eardrum has burst 3 times since September 2023.

Being constantly sick, we ended up in hospital beginning of July. He was admitted with Tonsillitis and Otitis Media again, we got discharged after a week. (Up until the discharged date he was on 4 cycles of antibiotics in only 28 days) A week after we got discharged he got an eye infection, tonsillitis again, Otitis media and his eardrum burst for the 3rd time. 31 July he started antibiotics again, Finished the cycle on Tuesday morning, school called with him being very sick and having a fever. After a suppository and pain and fever syrup his fever did not break. Back to the doctor that same day, fever 39.6 , started second cycle of antibiotics back to back and we finished that cycle on Sunday. It was tonsillitis AGAIN. With an infection count of 54 which should be less than 5.

You are willing to pay for a week stay in hospital but not willing to authorize his operation. It’s costing you more on GP visits, pediatricians, ENT specialist visits, blood tests, hospital visits than to just solve the problem and spare my child’s health.

His Tonsils are the root of the problem which leads to Otitis Media the whole time. His Tonsils are enlarged standard grade 4!!!! This causes eating problems, speech problems, breathing and sleep problems just to mention a few. His fever spikes up to almost 40 every second week. With his eardrum that burst for 3 times now we are facing hearing problems as well. ENT are surprised that he haven’t chocked yet due to the size of his tonsils. He is losing so much weight and this affects his growth.

You have declined our request for Tonsillectomy, Adenoidectomy and Myringotomy 4 times now. Now get this. We know that from the start of the new year These procedures are now on the list of standard exclusions on Discovery Key Care plus. BUT I HAVE PROOF THAT YOU STATE YOU STILL COVER EMERGENCIES AND STILL COVER THE PROCEDURE IF IT MEETS OUR PRESCRIBED MINIMUM BENEFITS on the plan. Now…all the procedure codes, and everything else from the ENT meets the PMB! Still you decline. While in hospital, (July) we app**** for authorization the first time, within 24hrs from when my child was admitted which is within your time limit to let it classify as an emergency. Still you declined. Now please explain to me what more do you need for it to be classified as an emergency???

ENT Specialist suggested the procedure needs to be done ASAP. He was booked for Tuesday 13 August and you kept on stalling on feedback and authorization and I had to move the operation out another week. ENT can only do the operation when his tonsils are not infected so this should be done as soon as possible. Doing Grommets alone in this case will not solve his problem. Because of his tonsils being Classified as stage 4, and the enlarged adenoids we will have repeat procedures for Grommets as they will keep on popping out because of the pressure on the ears. So this will keep on costing you Money and putting my child’s health at risk with repeat anesthesia.

Let me tell you, I have always been extremely happy with Discovery. Even now that we are on Key Care plus. (Previously on Delta Saver) the Main member of this Medical aid have been with you since 2011. We are paying just short of R10 000 a month, and you are not willing to put my child’s health first. We have done everything in our power to get you the sufficient reports from the pediatrician, ENT specialists (two different ones to get two different opinions, and both state that this needs to be done in order for my boy to be healthy again) all of what you requested and still you can’t authorize his procedure.

I have all the reports on hand, and photos of what my child has been through these past few months, And hopefully someone will see this and step in because this is really not up to Discovery standards!!!!