Sports Injury Benefit

I had x-rays done but only after did Discovery inform me that the GP needed to activate the Sports Injury Benefit and as a result my claim was rejected.

After numerous emails to Discovery support I keep on getting the same response "Please be advised that all benefit information is readily available on the Discovery website and specific benefit guides and it remains the members responsibility to confirm benefits before receiving treatment."

I find it seriously condescending when as a member, I believe I did my best to get the necessary information: - The first area of information consulted was the "Your 2020 Health Plan Guide" email. This email consists of the product information summary, the 2020 Health Plan Guide for the Smart Series as well as a video showing a summary of the benefits. The only reference to the Sports Injury Benefit is the following "The Sports Injury Benefit includes defined cover for specialist consultations, basic x-rays and treatment by al**** health professionals, when referred by a Smart network GP".

- The second area of information consulted was the Discovery app. Under the Health section of the app is a separate section that shows the "Cover" given under my plan. Under the "Day-to-day cover" section the following information is given "We cover basic x-rays, two specialist visits and a total of four visits to a physiothe******, biokineticist or chiropractor when related to a sports injury - if referred by your Smart Network GP."

- The last area of information consulted was the Discovery website. Under the smart series section of the website under Day-to-day cover the following information is given "Cover for sports-related injuries: basic X-rays, two specialist visits and a total of four visits to either a physiothe******, biokineticist or chiropractor when referred by a Smart Network GP." On this page it further states that this is only a summary of the key benefits and that the health plan guide needs to be consulted for more details. This is the same document that I mentioned and consulted under the first area of information detailed above. Furthermore I consulted the documents section of the website and specifically the section labelled "Discovery Health Medical Scheme - Rules for membership". I went through all of the documents related to the Smart Series and once again the only mention of the Sports Injury Benefit that could be found was the following "Basic x-rays, specialist visits and al**** healthcare services (either physiotherapy, biokineticists or chiropractor) for sports related injuries" & "Up to a maximum of 100% of the Discovery Health Rate subject to referral by a Smart network GP.

It should be clear from the above that every effort was made from my side to get the necessary and correct information. The fact that the sports injury benefit needs to be activated is not mentioned in any of the information nor is any reference made to the separate sports injury benefit document. All of the documents state the same thing, that the only requirement for the x-rays to be covered is that the member needs to be referred by a Smart Network GP and in my case, this was the procedure followed. The statement that the information is readily available on the Discovery website is not correct, even doing a Google search for "Discovery Smart Injury Benefit" does not give a direct link to the Smart Injury Benefit document that details that the benefit requires activation.