Unacceptable service from Discovery Medical Aid

In 2018 I went to the Doctor to check if everything was fine with my reproductive system ,at the time my mum and her sister had both suffered from clots, my Mum was still in ICU from a clot clogging 1 of her arteries and given her a massive heartacttack, my mum sister a clot in her Lung and previously her elderst sister DVt a clot in her leg. Even my cousin has this condition. I was sent for some test and found that I have a clotting gyne and was told by my OBGYNE and a Professor in General Medicine that if I fall pregnant there is a great risk of loosing the baby or even dying my self because of complications that will arise , I was not allowed to take any Birth control as it will increase my chances of clots and I was Diagnosed with PCOS in 2017 after I had my Son which was born premature because of the clotting disorder. Previously I also miscarriage in 2015 not knowing the causes.

January 2020 I found out I was pregnant with my 2nd child , it was the 30th January 2020 I was 6 weeks pregnant and was told I need a medication called Clexane to thin my blood and help carry my pregnancy full term these Injections cost R3200 for a month supply ,which I had to take 1 per day. I had been on ecotrin since 2018 when I was Diagnosed 1 tablet per day. My doctor advised that I put an application through to my medical Aid to assist with payment for the medication as I could not afford it. My Doctor sent through the application on the 4th February 2020,

I called discovery a few days later no assistance was given , I than sent through a motivational letter on the 10th of February 2020 I followed up on my application no response was given, on the 7th February i sent though a letter of motivation explaining my situation and my family history no response was given.

On the 27th February 2020 I went to see my Gyne as I was bleeding and found that my baby heart stopped due to a clot and I was told by my Doctor that I really needed the Clexane to help with this as I wasn't taking it we were waiting for the medical aids approval and for my Husband to get his salary to buy the injections. On the 28th February 2020 the Doctor induced labour before doing a DNC I experienced 5 hours of labor. I called discovery to notify them and ask them as to why did they not respond to the application and my letter no one could give me an answer, they Got a lady by the Name of Sam to contact me I explained to her what had happened, she Investigated my case and told me that it was a fault on discovery part and that if I fall pregnant again that my doctor should put through the PMB application and it will be approved and that they are going to change there procedures as her Investigation lead to see that the way they go about things wasn't helping anyone.

On the 18th March 2020 I received an email from the PMB department from a person named Dr Dhash Padayachee (operation executive) Declining my application for the medication i needed. The response came after my baby had died at 9weeks 5day , it came after having to experience labor for 5 hours for my little Angel I will never get to see, hold ,or touch. It came after I had notified discovery of the reprocutions of there actions and service and by than it was to late.

On the 11th of May 2020 I went to my Doctor and found out I was pregnant yet again even tho I was told that I would need fertility medication if I ever wanted to conceive again, by the Grace of God I was given another chance, My Doctor confirmed that It was to early to start the Clexane as we had to wait to hear the heartbeat. On Wednesday evening the 13th March I was rushed to hospital as I began to bleed, I was treated and a specialist found the heartbeat and Immediately put me on Clexane and progesterone to assist in keeping my baby alive.

I contacted the lady called Sam at the discovery to tell her that I was pregnant again and that I need the clexane she handed me over to a lady called Nicole a Client Manager. I explained my situation to Nicole and give my Doctor all the information I was given by Nicole , I was told to tell my Doctor rather to call in to a discovery doctor for approval of the medication and was given the call center number , my doctor tried for day and I explained to Nicole that my doctor cannot wait on hold as he has other patients to see, he than submitted another pmb application with no luck, the last Correspondence I sent to Nicole was on the 7th June 2020 and no response was given by her.

I have been paying R3600 per month for my medication, I even lent R3000 from my 77yr old grandmother , my family has been assisting in helping me with my medications , my Husband gets commission as he tries to consult and when he does we buy enough medication. On September 19th 2020 I was told I have Placenta preavia and that I need a C-section done and than I was notified my the doctors office that my Benefits has been depleted and that I only get two scans per year. I called in to Discovery to ask them to please help me as this is the situation and I need to know if there is an application I can fill out to obtain more doctors consultation and scans , I was told that my previous pregnancy was nit deregistered on there system, and that the new pregnancy was not loaded, I told the consultant that I did indeed notify Discovery when I lost my previous pregnancy and also when I fell pregnant again, I took days for them to sort this mess out, I was told that a client Manager would contact me which she did and than the lined dropped and did not receive a call back. I than called in because I need to know what can be done as I cannot afford my medication and R1250 consultation which I needed both ,as the Doctor needed to check if everything was fine. Eventually Nicole called back and activated my Maternity benefits which made no difference as I still had no consultations. She also emailed me application forms , that was end of September, I seen my Obgyne on the 17th October and I was handed the forms to submit, I emailed the forms on the 20th October to discovery PmB department and to Nicole, Nicole yet again has stopped responding to my mails. The PMB department yet again on the 23rd of October emails me declining my application for Clexane and more visits and scans giving no explanation as to why the declining my application and yet again its an email from Dr Dhash Padayachee.

All I need is assistance with visits to see my Gyne im due on the 7th January and scheduled to have a C-section in December 2020 due to my placenta preavia.

I will continue to purchase my Medication but I cannot afford the fees of the Doctors consultations, so far I owe my R2250 for scans that Discovery hasn't paid for ,I have another appointment on the 14th November and than I have to pay the full consultation fee, my Doctor asked for just 4 more consultations and Scans but I was declines by discovery, I have been on Discovery medical Aid since 2014 and I have never experienced service like this from them before so why am I receiving such horrible service now when I need my medical Aid the most, 2020 is such a difficult year for everyone and this is how I am being treated by Discovery, I really do not know who to contact or get in touch within Discovery to assist me this. The only reason that I am still pregnant is because of taking the clexane , progesterone and ecotrin. This is my story and I hope after writing this that discovery can really Change there procedures and rules so that the next women /Person does not have to have such difficulty with Discovery and not experience loosing a baby because Discovery refuse to help with Medication needed.