DT
Dale T

1 reviews | Active since Jan 2019

20 Jan 2019, 15:14

Spine Surgery Denied

I been having pain in my neck, shoulder and hand with nub-ness, pins and needles down my arm for the last 10 weeks. During that time I was on anti-inflammatories and even had a course of Steroids to relieve inflammation. There was no improvement and I was eventually medically disembarked from the ship I work on. On arrival back home I went to my GP who referred me to a Neurosurgeon. I was sent for an MRI of which Discovery only covered 2/3, the rest came out of my medical saving which had accumulated. The MRI showed a badly herniated disc at C6 in my neck that was pinching on the nerve bundle that goes down my left arm. The Surgeon immediately prescribed surgery to remove the disc and replace with a prosthetic. Discovery denied me this surgery on the grounds that I hadn't had any "Conservative" therapy. There is no Conservative therapy to fix my issue given the time that has already passed and all that is happening whilst surgery is delayed is damage to the nerve bundle. A letter of motivation from the Neurosurgeon for the urgency of the surgery was submitted to Discovery. They immediately asked for more information. When that was submitted, they waited another 3 days before requesting a new set of irrelevant information - delaying tactics. I am disgusted with the way they are trying to avoid paying. I have had to turn to my company to try and cover my surgery. Discovery, any nerve damage that is caused every day I am delayed will be for your account on the grounds that your lack of urgency contributed to the damage. You think you are secure in the knowledge that you have Medical Aid, you are not! Just try and claim and see what happens.

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Replies (4)
Discovery Health
Discovery Health's reply21 Jan 2019, 08:54
Official
Dear ***

We’re sorry to hear you’re dissatisfied. Please give us a chance to look into your query and we’ll be in touch soon.

Kind regards
Discovery Health Servicing Team
DT
Dale T's update23 Jan 2019, 22:42
Reviewer Update
I have already had my surgery thanks to AP-Companies insurance though my company. No Thanks to Discovery who has actually spent nothing on me just my own money from my medical savings plan. Nobody from Discovery has contacted me The one time I needed you Discovery Health you *****ed me! When I was at my worst in ********** pain you kicked me down and left me to find an alternative provider. I am now looking to replace my Discovery cover with another provider. Your Coastal saver actually offers me a very bad deal. R5000 per year for out of hospital. What will that get me? Nada! 1 dentist visit and one MRI that I have to pay R2900.00 out of savings. Your next correspondance will be to ask for more stalling tactic information. Well, its done, My surgery is complete no thanks to you. I just have to ask if you are happy that you managed to avoid paying my claim. This was your mandate from senior management to avoid payment as much as possible. As it is you only pay 100% when you know full well that everyone charges 300%. WHy make us get Gap covee and just pay 300% medical aid rates.
DT
Dale T's update23 Jan 2019, 23:03
Reviewer Update
You Won't look into this. I had to go into hospital as a private patient despite having Discovery Medical Aid. This meant I had to get a lot of letters of Guarantee from my companies insurance company to get the hospital to admit me. i am now claiming from an old Liberty Hospital Plan policy to help me out given the shoddy and non excistant urgency from Discovery. You clearly care nothing for your patients in the worst time of their lives.
Discovery Health
Discovery Health's reply25 Jan 2019, 12:57
Official
Dear ***

As soon as we have finalised this matter, we will provide you with feedback.

Kind regards
Discovery Health Servicing Team