Stressed Mother of a special needs child

Good day.

Do I have to fight for everything that has to do with my daughter's health with this medical aid? I can't even get therapy sessions approved that I app**** for via PMB. If it's not chronic meds, it's consumables. Below it is an email from her The****** account manager for the outstanding amounts that have not been paid since last year.

Carla spoke to you about us struggling to get some of Bohlale’s physiotherapy sessions paid from PMB since 2024 with certain sessions up until to date.

I just want to give you a run down with all my struggles I have had since last year (Some sessions they eventually paid, but herewith the following: (Discovery pays for certain sessions and other sessions they don’t pay for, so there are gaps in payment which does not make sense - for instance, they paid for the session on 20/05/2024 but then they don’t pay for 27/05/2024, then they pay for session on 15/07/2024 and 22/07/2024 but they don’t pay for session on 29/07/2024 or 11/11/2024 but then they pay again for 23/01/2025 as well as 04/02/2025 – every call centre agent I speak to at Discovery gives me a different story)

I have sent numerous emails to Discovery and phone calls (I have attached the latest orrespondence that I have sent to Discovery with reference numbers – there are more emails and phone calls that I had to struggle last year to get paid, which they did with some of the sessions that I have not included in this email. Please see attached:

26/01/2025 – Email Reference Number – ***1/02/2025 – Email Reference Number – *** I phoned Discovery on 25/04/2025 to AGAIN query the outstanding amounts and herewith the following reference numbers Discovery gave me for my call as they said these sessions was not linked to the PMB Basket of Care:

27/05/2024 – R705.25 - Authorisation number – *** – Reference number – *** 29/07/2025 – R705.25 – Authorisation number – *** – Reference number – *** 29/10/2024 – R705.25 – Authorisation number – *** – Reference number – *** 11/11/2024 – R705.25 – Authorisation number – *** – Reference number – *** 18/02/2025 – R734.85 – Authorisation number – *** – Reference number – *** (They paid this amount from savings, so I reversed it and they said they will amend the claim under PMB (Still outstanding) 04/03/2025 – R734.85 – Authorisation number – *** – Reference number – *** (When I put claim through it says no funds in MSA – they will amend the claim under PMB (Still outstanding) 15/04/2025 – R734.85 – Authorisation number – *** – Reference number – *** 06/05/2025 – R734.85 – Authorisation number – *** (Not paid as it says no funds in MSA) 27/05/2025 – R734.85 – Authorisation number – *** (Not paid as it says no funds in MSA) Total outstanding from Discovery since 27/05/2024 – 27/05/2025 – R6 495.25