Still Disappointed !!!

I signed up with Discovery Health on 1 November 2017.

Since then I have had multiple denials in regards to surgeries and procedures that we need.

I cannot upgrade my medical aid plan from Keycare Plus to Coastal Saver because according to Discovery this is not allowed in the middle of the year and no exclusions will be made for us.

I tried sending in my spouses request and attached his MRI of a year and a half ago (18/01/2017) because Discovery also does not cover MRI's on the Keycare plan. I also motivated why he need the spinal surgery and how it is impacting his every day life but they still denied us, stating that this is a general exclusion and not a PMB case (According to the MRI of a year and a half ago). Since then he went to the gym and went on with his life living with the pain, until March 2018 when the pain just became so unbearable he couldn't just handle it anymore. Discovery approved all specialist visits but denied any treatment plans. He's at a point where he cannot work properly and where this is at such point where his every day living is affected in a bad way. All the pain pills he have been prescribed did not work as we had hoped and he cannot go on with this pain anymore. It is affecting his movement and all his mobility in his lower parts of my body. All diagnoses from all the specialists he went to see was all the same, new MRI and surgery is needed.

I found a lump in my right breast in April 2018. The tests said it is not cancerous - All tests are not 100% (although it has been growing at an immense rate and has grown since then from the size of a 5c to the size of a golf ball/ tennis ball). The tests also identified this lump as an fibroadenoma. Even though we expressed that I do have breast cancer in the family history and my grandmother, mother and aunt has lumps in their breasts as well, Keycare denied me an operation to remove this lump as requested by a Keycare Doctor to remove and sent this lump for more testing. (tests done include: physical feeling of breast test, Fine needle aspiration and a sonar was also taken where health care professionals came to the conclusion it is a fibroadenoma). The last doctor I went to see, who is a Keycare doctor, advised me to seek authorization to do the operation ASAP as this lumps can grow into very big lumps and cause problems later on. Still I was denied treatment and the operation to remove something that can potentially be harmful in the future. No one can predict the future.

After 2 months of frustration and us trying to reason with Discovery in regards to making an exclusion for a Medical Aid upgrade before the given time, We were once again denied. We have exhausted every thinkable option in regards to get this done.

After several calls, they stated it has to be a PMB or a life threatening case before any exclusions can be made for us. When we reach this point, I am afraid that it will be to late.

They also stated that there are other treatment plans, none of which are covered by the Keycare plan. Even if we decided to go with these treatment plans ( and pay for it ourselves - which we don't have funding for, hence why we got medical aid) we would rather want to follow the Doctors opinion in the case rather than what Call Agents suggest that can't really help and have no medical qualifications.

There are also a miscommunication between every agent at discovery. One agent told us that an exclusion for upgrade can be made with the Medical Scheme and another said it is not possible. I don't understand or know who to believe?

Basically what they were telling me and their advise to me was, either wait until March Next year and hope nothing gets worse or be halfway on your way to death before we will try to help you as best we can according to your plan.

I got medical aid to help me when I have a medical emergency or need surgery, I am being denied everything I am trying. I feel as if no one at Discovery is willing to listen to me or help me in any way, but I need to pay them just to look good in a glass box at the top of my bookshelve, laminated and locked away, never to be used.

If no exclusion can be made in regards to treatment, there must certainly be a plan to upgrade me on my medical aid plan choice. I expressed that I am willing to say that I will not downgrade for a certain given time (Not that we were planning to once we upgrade) because nothing in the lower region of the Medical Schemes covers what I need, they still denied me.

I am just fed up with being denied every time I have a request involving treatment. The disappointment is too big every time I need authorization for something and then be shot down by my Medical Aid.

04/06/2018 Still as dissapointed as I was when I initially typed this review. Keycare is a no go for anyone who needs medical aid. They don't pay for any breast surgeries although I did make it clear that I have a history of breast cancer in my family (They now want proof) and did all the tests they require. Stating to me about other plans they have that will cover this right now, knowing that I am not "allowed" to upgrade my plan until January 2018. Dissapointed does not begin to explain what I am feeling right now!