South Africas Biggest ******* (Plot twist, its not the ANC)

Discovery are *********, there is no other way to put it.

I have a fractured sesamoid bone (one of two small bones beneath the ball of your big toe), and require surgery to relieve my relentless pain, and inability to partake any any sports.

Discovery are refusing to cover the in-hospital treatment, where my orthopaedic surgeon would remove the bone and i would hopefully be able to live without feeling like i have a thorn lodged in the ball of my foot.

After the formalities of hospital pre-authorisation, i received an bot generated email: 'Your request has been reviewed according to the rules of the Discovery Health Medical Scheme and the Essential Smart Plan. We regret to inform you that we have declined funding for Mr Lubner's admission and procedure, because this procedure is listed as a Plan exclusion in the Scheme rules for the Essential Smart Plan and there is no confirmation of a Prescribed Minimum Benefit condition.'

I was in shock at this email, and quickly checked my Essential Smart plan for the exclusions, and could not find anything that would identify a fractured sesamoid as an exclusion. Then i saw it, under extra exclusions, 'Correction of hallux valgus (bunion)and Tailor’s bunion (bunionette)'

After a further re-application for the surgery and further refusal by Discovery, they still maintain that they are within their rights to not fund this procedure as they see it as a bunion. My surgeon, his assistant, and his entire staff contingent are speechless at the blatant ******** behaviour, by Discovery.

A sesamoid has nothing to do with a bunion, but in Discovery's eyes it does. They are not only blatantly denying a matter of fact, they are denying my specialists expert advice (arguably the most experienced orthopaedic foot and ankle surgeon in SA), but further refusing my surgeon to discuss the review teams decisions on denying funding, after he sent through a copy of the recent MRI report, as well as a letter of motivation.

I have since missed my surgery date and have no direction on how to proceed. Stuck in limbo, with an agent having the absolute audacity of trying to sell my a plan, saying 'this could have been avoided if you only had a higher more premium plan'.

Sue Ramlakhan has been helpful up until this point, where as she now ignores my mails and calls.