Unacceptable Service Delivery and Misleading Info: Discovery Gap Cover – including Supplementary Gap Cover

RE: Discovery Gap Cover – including Supplementary Gap Cover Earlier this year, I have inquired about the Discovery Gap covers. I was uncertain how Gap covers worked and decided to contact Discovery to rather speak to an advisor to raise my concerns and many questions rather than blindly taking a Gap cover over the internet or through other service providers or telemarketers. Getting in touch with Discovery was an obvious choice, since I have been a member of this medical aid for quite a few years now and was quite satisfied. Whilst having a very lengthy telephonic conversation with Lucas (sales person of Discovery Gap cover), I had a set of questions to ask with regard to everything I was not sure of. I deliberately asked him about the waiting periods when he informed me that there were set waiting periods for certain procedures. One of the questions I had in this regard was regarding a hysterectomy. I deliberately asked him when the waiting period was applicable. He told me that the 12-month waiting period did not apply to emergency procedures. I then asked whether it imp**** that the 12-month waiting period lapsed if the hysterectomy was an emergency procedure. He then confirmed that this was the case. Unfortunately, as fate sometimes has it, my gynecologist informed me two weeks ago that I needed a hysterectomy due to unforeseen challenges in my health. I immediately contacted Discovery for the required pre-admission procedures. This was done on 15 October. When I inquired about the Gap Cover, I was told to contact the Gap Cover department, since they worked separately from Discovery Medical Aid. On 20 October I spoke to Bongani at the Gap Cover department. He informed me that Gap Cover will not cover my extra expenses, seeing that this procedure was excluded from the benefits for 12 months. I explained to him that I actually asked Lucas deliberate questions and that this was an emergency procedure that cannot wait a few more months. I requested to speak to a manager who could help me solve the problem. I was connected to Mr Francisco Prins – Client Relationship Manager- (Gap New Business and Servicing). I explained in detail my predicament and that I was 200% sure that Lucas told me that only a 3-month waiting period app**** in the case of a hysterectomy due to an emergency procedure (and thus unforeseen circumstances). He told me that he would look into the matter and that it would take 2 – 3 working days to get the transcript of the conversation between Lucas and I and that he would make it priority and get back to me. On Tuesday, 26 October (4 ½ working days after my conversation), I contacted Discovery, staying on line for nearly half an hour waiting to be connected to Francisco – each time explaining my whole situation from the one to the other operator. At last, I spoke to Byron, giving me Reference Number: ***, explaining that he was having difficulty connecting my line with Francisco’s. He said that he was not able to, but that Francisco would IMMEDIATELY contact me back, since he awaited the connection. I explained to him that I was not happy getting off the line, since Francisco already HAD TO get in touch with me, but did not do so. He assured me that he would immediately contact me back. Early on Wednesday, 27 October I got a missed call whilst in a meeting. Francisco then sent me an email shortly before 7:30 saying he “noted I tried to get in touch the previous day”. I immediately mailed him back at the first available time between my classes. He read to me the report that came back with regards to the transcript. The report abruptly stated that all conditions relating to waiting periods were read to me by Lucas and that the 12-month waiting period unfortunately still app****. I ONCE AGAIN told him that it was indeed read to me – I never disputed that. However, I specifically asked quite a few questions, under which the ones stated above already. No note was made of this during my conversation with Lucas in the report. Francisco then said in that case, he needed to ask for the whole conversation to be listened to and not just a transcript and that this may take a while. I explained that I really needed to undergo this procedure as soon as possible and even had a motivational letter from my specialist to confirm my predicament. I expressed my utter dissatisfaction with Discovery’s service – including his service – or the lack thereof. As I also explained to him, why would I be so certain of my case if I had not made proper notes whilst discussing the Gap Cover to be taken out with Discovery? And secondly, would I have taken out the more expensive option, and even have been talked into taking out the additional Supplementary cover if I had not been satisfied and at ease with all the feedback Lucas had given me? I told Francisco that I was not happy and that I was very dissatisfied with the poor after-sales service and the obvious misleading sales tactics with this regard and that I wanted to know who else – in a more superior position than himself - would I be able to take this up with. He assured me that he was the one to handle the enquiry and that he would make it priority. I also told him that I would not leave the matter as is and would definitely take it further as I was in a haste to see what the outcome would be, since I was sure that I was not the wrong one “misunderstanding” the waiting periods (as was also said to me during a previous conversation). I know I am just a small fish in the Discovery ocean and to this medical aid, I am just one member amongst thousands – that is clear when judged by their way of assisting a valid enquiry as mine. However, I am truly so perplexed by the ridiculousness of this whole situation, that I am currently busy finding another medical aid and considering to immediately cancel my Discovery Comprehensive Gap Cover of R327 and Supplementary Illness Benefit Gap Cover of R205. I’ve never been hospitalized whilst being a Discovery member, but now that I have a medical problem, there are far too many stories and far too few who care. What a shame that someone like me does not matter to a big medical scheme like Discovery!