Urgent Escalation – Callous Failure of Service and Outstanding Payment

I was admitted to hospital in a critically ill condition by my specialist who called ahead to secure a bed and admission. On arrival, hospital reception was dilly-dallying and said that the Discovery representative was offsite and would only be back in about “3 hours”. The specialist walked in when this was happening and got angry stating that this was clearly a PMB case from looking at me AND that he had informed the hospital hours before my arrival to provide sufficient time for admin. He took me to the ward to be treated immediately. Shortly after admission, I was informed that I was within hours of kidney failure due to extreme dehydration. This doctor not only saved my kidneys and possibly my life with his fast action - but also saved Discovery A LOT of additional costs and possibly long-term costs!!!!!

The standard of care I experienced at the hospital was deeply concerning (a matter I have already formally raised with Discovery & Sandton Clinic, with no meaningful accountability or recourse to date).

But it’s my experience with Discovery has been equally unacceptable. (Bearing in mind that I have been a loyal customer for over 25 years now).

It is important to state plainly: had I or my doctor not been fami**** with the workings of these systems and proactive by taking initiative as stated above the outcome could have been materially worse - I could have had kidney damage or worse! Discovery you don’t seem to care about this! I say again, if we had listened to the reception’s advice, which was that Discovery said it would take 3 hours for authorization - that’s about 5 hours in total by the way - I could have had kidney damage or worse!!!!

Now, more than six weeks later, Discovery continues to delay payment of a relatively modest claim (approximately R1,000–R2,000) for a specialist who not only charged fairly—at rates often comparable to a GP—but who was the only person / human being who acted with urgency, competence, and genuine care. In my view, his intervention was critical to my recovery.

In contrast, Discovery:

* Failed to provide timely authorisation during a medical emergency * Has required me, repeatedly, to justify and “prove” the legitimacy of my condition * Has subjected me to an excessive and fragmented administrative process, including surveys, explanations, and over 15 email exchanges * Has demonstrated a lack of clinical and case awareness, evidenced by requests for irrelevant documentation (e.g. a request from the KZNescalations team and the Clinical Team for scope report for a procedure that never took place?!?!? How is this possible?!?! And it’s in writing!)

This pattern reflects not only inefficiency but a concerning lack of coordination and professional diligence.

I will not continue engaging in repetitive correspondence with multiple representatives who lack context or decision-making authority. This approach is both ineffective and unacceptable.

Accordingly, I require the following:

1. Immediate settlement of the outstanding specialist account (I’m sure Discovery can pay a bill of a few thousand yeah?) 2. Direct contact from a member of the Executive or Senior Escalations team (which is not the ExecutiveOfficeKZN team) 3. Assignment of ONE single, accountable point of contact person who is empowered to resolve this matter in full

It is deeply troubling that an organisation entrusted with members’ health—indeed, their lives—would handle a case of this nature with such disregard, particularly over an amount that is immaterial in the broader context of care (and after all the other hurdles one has had to cross due to Discovery’s lack or support and incompetence!!!!!)

You guys should be giving the doctor a bonus for outstanding professionalism and for saving you money and profit!!!!

This matter now requires urgent, competent resolution.

I expect your prompt response and a PHONECALL from a person who is competent to handle this and get it sorted and settled without further back and forth or frustration and time wasting!!