"Scheme" emphasis on "Scheme"

After taking my daughter(12) to see a specialist as she battles with a particular condition, the specialist advised that it would be best to do a small procedure now as long term it will affect her psychologically and physically as this condition keeps her out of school, for at least 2 days every single month.

The Doctor sends through the authorization request same day, along with a detailed motivation as to why she deems the procedure necessary Naturally i follow up the very next day and am told that it takes 3 - 5 days for authorizations to be completed, (No problem) i understand however i stress to the agent on the phone the Doctor has requested to proceed within 5 working days so some sort of urgency needs to be put on it as the Dr also requested this to be done during this school holidays in order not to further impact her attendance.

Two days goes by, i call back and enquire, only for the agent to ask me if im sure the correct authorization has been loaded as she sees My daughter is only 12, I then ask her to give me the description , her response was it has been loaded as a "Hysterectomy" , i am now horrified as this is completely incorrect and needs to be rectified immediately, she calls the Doctors rooms where she states that the agent who captured the request made a mistake with 1 digit, wow , a mistake that can cost my child her entire future, never the less it has been rectified.

48 hours before the procedure , Discovery comes back and requests more "CLINICAL Information" not a problem , Dr sends this through, 24 hours before procedure is scheduled , i call back again and speak with an agent who put me on hold for almost 20min as i stressed the urgency of a decision, they then return and say unfortunately the authorization was declined as it is not apart of the scheme and even though it was motivated twice , i would have to do this privately to my own account. Okay so here is my gripe we and thats just my family of 4 pay +- R9000K a month to this Scheme, we paid R1k+ to see the specialist for our daughter as our GP cannot assist her hence she was referred to the Specialist, what exactly am i paying for? this is really A "Scheme"