Unhappy Customer

Last year June 2023 I was rushed to hospital and had an emergency admission because I had severe back pain and couldn’t walk. In hospital the doctors did the x- rays and MRI scans to find the problem. Results showed that my lower discs Had issues and my neurosurgeon performed Facet Injection. After my hospital say I was left with over 10k bills that I need to pay out of pocket, I then disputed these bills. Discovery health came back to me saying that I was admitted under the spinal care program and this program allows only for 5 days in hospital care and the injection is not covered in hospital it comes for your day to day. At this time I was on the essential saver plan. I then upgraded to the classic saver plan because now I know I have a back condition. On the 14th November 2024 I again was rushed to hospital because my back pain has returned. Severe pain came back and I struggled to move or sleep hence my hospital admission again. My neurologist requested I do a new MRI scan so that we can see what the problem is and if there is any disc move or rapture , he also advised that Discovery has declined the procure he wants to perform. On the 15th November I called discovery and I asked the following questions: 1. I need to do MRI scan am I covered for in hospital, they advised that I need to pay 3k from my day to day savings and they pay the rest. My concern is that I have not been to hospital for the year 2024 this is my first stay, I am now on classic saver plan, I have unlimited hospital cover and 200% doctors rate “according to the cover details”. This is my first MRI and I need to pay 3k out of pocket??? Please explain this 2. The procure my neurosurgeon wants to perform is not supported my the medical aid, all other injections are supported except this one , I need to pay out of pocket? Please explain 3. The spinal programme allows you to be in hospital for only 6 days per year , so what if I had to be admitted twice because the procedures are not working so then I need to pay out of pocket if I exceeded my 6 days already??? Please explain

I am now stuck in hospital under medical because of my pain, I do not want to do a back operation because the pain block the doctor prescribed last year worked for me , it helped me for 18 months .

My concern is I have medical aid with unlimited cover and now that I am admitted there is issues with doing the basic scans and getting the medical care that I need. And apparently this is the spinal care programme rules for even the comprehensive plan customers.

Other medical aids offer this procedures and it falls under the in hospital fund.

I am still very unhappy with my medical bills of last year and now I am again in the same situation and my medical aid which I pay every month without fail cannot assist me.

I urgent everyone on the higher plans to look that this issue and request Discovery to explain this part to you because you will think you have the cover and then they come and tell you of a spinal programme that doesn’t help you with what you need.

If I was admitted into hospital for another illness and required a MRI would Discovery give me the same story about partial must come out of your savings and the other must come from in hospital fund. Or will they now cover the full MRI and maybe x-ray?? I am admitted into hospital why is all my stuff not covered ????

Look at also at the time of the year, our funds are almost exhausted and now I wonder why because everything comes off our day to day and not our medical aid funds.

I am very disappointed in this .

Last year I wrote a report of my hospital stay and disputed it with discovery, all they said was you were on the spinal programme you were more the 5 days in the hospital. Even after I explain that yes I was over 5 days in hospital because they did not know what was wrong with me only after the MRI was done and a neurosurgeon was allocated it was then when I was diagnosed with a spine problem so how could I have known that my discs had issues , I am not a doctor hence I went to hospital to seek the care I need because I have a medical aid that suppose to take care of me .

I am very disappointed, laying in pain and I can’t be assisted because my medical aid doesn’t cover me even though I have unlimited hospital cover .