Unfair Business Practice by Discovery Key Care Plus

I would like to lay a complaint of unfair business practices by Discovery Health Key Care Plus

Discovery rejected my claim for a Specialist Doctor whilst in their plan they say they pay Specialist Doctors My 4 year old son has a delayed speech he attends a Speech The****** and Speech The****** discovered that my son has a tongue tie and referred us to a Specialist Doctor that helps children with tongue tie Dr Dean Gersun Dr Dean Gersun did confirm that my son has a tongue tie and he needs a minor surgery I was told by Discovery that i need to go to a normal GP Doctor to recommend me a Specialist Doctor and the Normal GP Doctor recommended Dr Dean Gersun to do tongue tie surgery Discovery Health declined our claim to pay us back the amount that we payed to a Specialist Doctor Dean Gersun because they say they approved our claim the 30th of October 2024 and surgery was performed 29th of October 2024 We explained to them that it took us 30 days to secure the appointment with Specialist Doctor and still doesn’t consider the fact that our son needed urgent assistance Furthermore Discovery Health doesn’t realized that GP Doctors are not Specialist and is not their specialties attend to tongue tie challenges Discovery Health did not explain to me all these terms of their that doesn’t consider medical challenges our children have to deal with their unfair and unreasonable processes We request the Health Ombudsman to investigate Discovery Health and fine them for this unfair business practices

Regards Phindile Mntambo ( Medical Aid Number ***)