1 reviews | Active since Feb 2011
Sad and Angry
I have been a Discovery member for many years. I have never needed them for any hospital admissions. I need a small eye op to be done. I called for authorization which was declined as the operation apparently must come out of my day-to-day benefits. My yearly savings this year were around R5000. Just the Doctors bill for the procedure is R15 000. That excludes theatre time, the hospital bill and the anesthetist. So youre telling me I need to deplete a YEARS worth of my savings PLUS pay in over R10 000 for a small eye operation?!? If it was heart surgery I would understand, but for a small eye operation thats ridiculous! I am on one of the lower plans but was told that it would only be covered on the Executive plan so it was of no benefit to change to a higher plan. <br> <br> I am SO angry about this as this operation could cure years and years of chronic headaches and help my eyesight immensely . I wish whoever made this decision to decline this op knew what it was like to live with daily debilitating headaches. IT IS NOT A BIG OPERATION in t he greater scheme of things and I am saddened by their \who cares"attitude. """
Thank you for your comment.
I investigated your query and confirmed we sent your request for funding for your procedure to our medical review team. The review panel declined your request for funding from the Hospital Benefit based on the clinical information provided to us. We will however fund this from your available day to day benefits.
We recognise that your doctor is in the best position to make medical decisions about your condition and treatment. In declining the funding, we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide about funding treatments to make sure the medical scheme can pay claims now and in the future. Discovery Health's role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable.
I hope this explains our funding decision and the process we follow to ensure we apply a funding policy that is fair to all our members.
Regards
Jashvir
Thank you for your comment.
I investigated your query and confirmed we sent your request for funding for your procedure to our medical review team. The review panel declined your request for funding from the Hospital Benefit based on the clinical information provided to us. We will however fund this from your available day to day benefits.
We recognise that your doctor is in the best position to make medical decisions about your condition and treatment. In declining the funding, we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide about funding treatments to make sure the medical scheme can pay claims now and in the future. Discovery Health's role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable.
I hope this explains our funding decision and the process we follow to ensure we apply a funding policy that is fair to all our members.
Regards
Jashvir