Unacceptable service

I have a hospital plan with Discovery Health. On 8 June of this year I became violently ill. I ended up in casualty in Kloof Mediclinic Hospital. I was so ill that I could not at the time pay for the emergency admission so my mother did so on my behalf. I did not respond to drips given to me by the casualty doctors and the doctor decided that I should be admitted. However, there were no beds available at Kloof Mediclinic that evening. There were also no beds available at the time at two of the other closest Mediclinic hospitals we tried. I was eventually driven late at night to Netcare Unitas Hospital. On arrival I presented the letter for admission to the hospital from the doctor at Kloof Mediclinic but the doctor at Netcare Unitas wanted to start over and said they were not allowed to rely on any of the test results from the tests which had just been run at Mediclinic Kloof (apparently because Netcare does not accept Mediclinic tests). But by this time it was already after midnight and I refused to have the same tests ran again from scratch and again have to pay for them for no good reason at all. I returned home where I recovered and where I later arranged and underwent a colonoscopy and gastroscopy and received treatment.

On 31 July I submitted a claim to Discovery Health for the money my mother paid on my behalf. I relayed what happened and the circumstances why I was not admitted to Discovery together with all supporting documents on 31 July 2017. I then promptly received a reply from Discovery saying my claim is rejected because I was not admitted.

I understand that my policy only covers in hospital costs if I have been admitted. The problem here is that I was clearly so ill as to require and justify admission but through no fault of my own I couldn't be admitted because there simply were no beds available. When I eventually reached a hospital that had an open bed I refused to waste, what I thought would be Discovery's money, to re-run tests that had just been run simply because this was now a netcare hospital and not mediclinic hospital. I did everything I was supposed to do and provided proof of the facts in my story by submitting supporting documents including the letter by the attending doctor.

It feels to me very much like my case wasn't even considered. The moment my claim came in it was just automatically rejected. This is not the what happens if you belong to a medical aid that claims to care about its members.

I have since tried to take the matter up through my broker but haven't even received a response. I joined discovery because of Vitality and my impression that they gave great caring and above all fair service. I now have to consider leaving it because it seems it actually does not care at all.