1 reviews | Active since Dec 2021
**UNACCEPTABLE DELAY IN AUTHORISATION FOR MEDICALLY NECESSARY ADMISSION**
I am extremely disappointed and frustrated with the way Discovery Medical Aid is handling my request for an authorisation code for hospital admission.
I have been a member of this medical aid for years and have consistently paid my contributions on time, without excuses and without ever expecting Discovery to wait for payment. Yet now, when I genuinely need my medical aid and require admission for treatment, I am being made to wait for authorisation while my request is supposedly “under review.”
**Why am I effectively being denied or delayed access to treatment through a medical aid that I have faithfully paid for and used for years?** When it was my responsibility to pay my monthly contributions, Discovery expected payment on time. Why, when it is Discovery's turn to provide the cover I have been paying for, must I wait up to 48 hours without even being given a proper explanation?
What exactly is being reviewed? Why has my admission been flagged? What concerns or suspicions does Discovery have regarding my request? Nobody has been able to clearly explain this to me. I am simply expected to wait.
This is not a routine administrative matter. **This is my health.** I require admission for medical treatment. My condition does not pause for 48 hours while Discovery conducts an unexplained internal review. What happens if my condition deteriorates while I am waiting?
What is most upsetting is the apparent lack of urgency or consideration for the seriousness of the situation. I have fulfilled my responsibility towards Discovery consistently for years. I expect the same level of commitment when I need access to the healthcare benefits that I have been paying for.
If there is a legitimate reason for this review, then tell me what it is. Explain what is being investigated, why it is necessary, and what provision is being made for my treatment while this process is taking place.
I am requesting **urgent intervention, a clear explanation and immediate resolution**. A patient's health cannot simply be placed “under review” for 48 hours without proper explanation while their condition could potentially worsen.
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
After making me wait while my request was “under review”, I have now received Discovery’s response. They have declined funding for my admission on the basis that the request is “not clinically appropriate” and have advised me that I must pay the hospital and all costs associated with the admission from my own pocket.
I wish Discovery would explain exactly what “not clinically appropriate” means in relation to my specific condition and the admission requested by my treating doctor.
What I find particularly difficult to understand is that Discovery states in the very same letter that they have not questioned my diagnosis or the treatment recommended by my healthcare professional. If that is the case, on what clinical basis was it then determined that my admission was not appropriate?
To my knowledge, this decision was made without Discovery contacting my treating doctor to seek clarity or additional information before declining the request. If there was information missing, unclear or insufficient, why was the doctor not contacted before a decision with such serious consequences was made?
I have been a member of this medical aid for years and have consistently paid my contributions. I have never told Discovery that my monthly contribution would be delayed while I “reviewed” whether paying them was financially appropriate. Yet when I need the cover I have been paying for, I am first made to wait and then given a vague reason for declining my admission.
I am not asking Discovery simply to reverse a decision without justification. I am asking them to properly explain it. What specifically about my admission was considered clinically inappropriate? Who made that clinical assessment? What information was considered? And why was my treating doctor not contacted for clarification before the request was declined?
Telling a sick member to simply pay the entire admission from their own pocket, without providing a meaningful explanation for the decision, is shocking.
Discovery, please provide me with a proper, case-specific explanation — not a generic reference to Scheme Rules and the words “not clinically appropriate.”
After making me wait while my request was “under review”, I have now received Discovery’s response. They have declined funding for my admission on the basis that the request is “not clinically appropriate” and have advised me that I must pay the hospital and all costs associated with the admission from my own pocket.
I wish Discovery would explain exactly what “not clinically appropriate” means in relation to my specific condition and the admission requested by my treating doctor.
What I find particularly difficult to understand is that Discovery states in the very same letter that they have not questioned my diagnosis or the treatment recommended by my healthcare professional. If that is the case, on what clinical basis was it then determined that my admission was not appropriate?
To my knowledge, this decision was made without Discovery contacting my treating doctor to seek clarity or additional information before declining the request. If there was information missing, unclear or insufficient, why was the doctor not contacted before a decision with such serious consequences was made?
I have been a member of this medical aid for years and have consistently paid my contributions. I have never told Discovery that my monthly contribution would be delayed while I “reviewed” whether paying them was financially appropriate. Yet when I need the cover I have been paying for, I am first made to wait and then given a vague reason for declining my admission.
I am not asking Discovery simply to reverse a decision without justification. I am asking them to properly explain it. What specifically about my admission was considered clinically inappropriate? Who made that clinical assessment? What information was considered? And why was my treating doctor not contacted for clarification before the request was declined?
Telling a sick member to simply pay the entire admission from their own pocket, without providing a meaningful explanation for the decision, is shocking.
Discovery, please provide me with a proper, case-specific explanation — not a generic reference to Scheme Rules and the words “not clinically appropriate.”