Discovery screwed me, they will screw you, get out while you can!

**proze** · 02-02-2012, 01:28 PM

Short version: I broke my leg. Discovery Health will not pay. Leave while you can before they screw you too.

**Strifehart** · 02-02-2012, 01:33 PM

More info perhaps?

When I broke my collarbone they paid for everything, granted that was 6 years ago.

Working in the medical aid industry, I trust Discovery more than the schemes which fall under the company I work for.

**Rollerball** · 02-02-2012, 01:41 PM

Ja, please more info as I just had my teeth done and they payed 10500 out of a possible 11200 so that's not bad going.

**phalen** · 02-02-2012, 02:05 PM

i was in hospital for two weeks, discovery paid for everything

i will not move to another.

**proze** · 02-02-2012, 02:15 PM

Happy for you all. Really. I broke my leg hiking. Nothing crazy. But they try pull this "you weren't admitted" nonsense. But a broken leg is a PMB. By law they have to pay. But they are refusing to pay for the xrays that were taken to determine the extent of the injury, the cast that was put on or the specialist who had to see if I needed surgery. Have you ever seen someone with a broken leg that didn't have a cast? Or who didn't have xrays? Anyway, I've run myself ragged getting all the info they wanted and spent hours and hours on the phone, all for nothing. So I'm moving everything from them, lock, stock and barrel.

**VPII** · 02-02-2012, 02:23 PM

Sorry to hear about what happened to you.
6 Months ago our company arranged for an independent company to come and present the various options / plans available with Discovery Health and help chose which one would best fit your personal need or work for you. One thing I learned is that there are number of plans in Discover which would cover for hospitalisation but only in certain / selected hospitals.
You might want to read through everything covered in your plan to see whether you may have one of the options / plans which would only cover for hospitalisation in certain hospitals.

Two years ago due to out of the unordinary events I woke up in the parking lot of a Medi Clinic and was taken up in ICU for 7 days together with an additional 3 days in the normal ward. I had undergone plastic surgery (unaware due to contusions on both frontal lobes of my brain) and two CT scans and in the end did not have to pay anything. I also had three check-ups with the Neurosurgeon 3months, 6 months and 18 months after I was release to see whether there may be any additional damages.

**proze** · 02-02-2012, 02:25 PM

That's what I don't understand. They'll pay for really hectic stuff that costs hundreds of thousands. I pay, all in all, upwards of R8000 per month to Discovery in various forms and they screw me by refusing to treat something as basic, but totally necessary, as a broken bone. Well, it's the last they'll see of me.

**Rollerball** · 02-02-2012, 02:55 PM

You must them proze. That is bullshit. Really fight them....take it to supervisors and then higher up...crap man

**RuneFire** · 02-02-2012, 02:58 PM

write to hellopeter and/or some magazines ? name and shame them.

**Tinuva** · 02-02-2012, 03:05 PM

Must admit I am pretty surprised at this. Then again I do know that in the event you are uncertain, call them before you spend money and make sure they will pay out to the specific hospital you are at. I know its a mission but I for one believe in rather save than sorry afterwards.

While I haven't had anything to do yet with any hospital, they have thus far paid for all the things I have done which is basic doctor visits, check up on eyes, all medicine I get from M-Kem, ect.

But I mean, if there are more people that have cases like you, they should speak up so that the public can become aware of it. Thus hellopeter is your best bet imho.

**Tanith** · 02-02-2012, 03:12 PM

For all xrays you have to insist at the hospital that you are admitted so that M-Aid will pay.

This is standard knowledge. I am surprised that you didn't know.

**proze** · 02-02-2012, 03:19 PM

Eh? Your solution is to be dishonest to "work" the system? With a PMB condition they have to pay for diagnosis and treatment. When you find a way to diagnose a broken leg without an xray you let me know.

**Pornolio** · 02-02-2012, 03:19 PM

Discovery has a really bad name out in the medical field... I am forced to go with my companies medical aid, and even though its not Discovery, its being administered by them. I cant even begin to tell you how many specialists and doctors I have been to last year, that once I hand them my medical aid card for registration, when they see the discovery logo, they already tell you flat out... YOU pay the accounts directly with the doctor, and you can claim it back on your own. They refuse to deal with Discovery. Its really that bad out there.

Even my Dentist... every single time they claim from the medical aid, I have to pay in money. Yet, I am sitting with over R9000 in my medical savings account. The other situation I remember when I use to be with Discovery was, when I wanted to have my wisdom teeth removed... ( I was on one of the classical plans, that was pretty expensive for a single person with no children / dependants ), I was told that Discovery would not cover me for in hospital removal... only local anesthetic. There is no way they were gonna cut and pull 4 wisdom teeth out of my mouth while I am wide awake... No way in hell :-p Anyway, I cancelled with them and went to Fedsure medical aid... no hassles.

Edit - If you think you have it bad... have a read on this link how badly this poor dude got schnaaid : http://mybroadband.co.za/vb/showthre...-Advice-needed

**larch** · 02-02-2012, 03:22 PM

Originally Posted by Tanith

For all xrays you have to insist at the hospital that you are admitted so that M-Aid will pay.

This is standard knowledge. I am surprised that you didn't know.

What she said proze, unfortunately just like any other business a medical aid is also one. So you need to follow protocol and read their terms and conditions very very carefully if you don't they refuse to pay. It is sad I know because they are suppose to care about your well fair first and the money last. I have learned this the hard way in the past. So now whenever I go in for something I do it by the book.

**Tanith** · 02-02-2012, 03:26 PM

Originally Posted by proze

Eh? Your solution is to be dishonest to "work" the system? With a PMB condition they have to pay for diagnosis and treatment. When you find a way to diagnose a broken leg without an xray you let me know.

It isn't about the diagnosis. Its about the protocol. You either make special arrangements (as you do with any operations that aren't life or death) or you get admitted.

It has ALWAYS been like that.

I am not unsympathetic to your plight but I always check everything with discovery, right down to my sonars for my diagnostitian. And it is a fact that when you break something you ALWAYS should request admittance. You don't actually get a bed, nothing changes exept their procedure for processing it.

When I broke my ankle we had to admit me too...

Edit: I just think its extreme to write off the entire Medical Aid just because you didn't read your contract or phone them.

**larch** · 02-02-2012, 03:29 PM

Get pre-authorisation --> Then Authorisation --> Fill in forms needed --> Give in @ hospital and Medial Aid --> Medical Aid takes it from there. Rince and repeat for each and every procedure.

**proze** · 02-02-2012, 03:47 PM

Very pithy, larch, but post something useful or don't post. You remember that, and then do it, at midnight when you're dehydrated and in pain, good fella.

My wife did call them, Tanith, they said it was fine to go to the hospital I went to. They just didn't tell her anything else. I know they're all the devil, PMBs exist because all the medical aids are bastards. But I can choose that this devil not get a cent more from me. What they're denying me is just over one month's premiums. If they'd done the right thing, they could have carried on making money on non-smoking, non-drinking, fit, healthy me for many more years.

**Jude** · 02-02-2012, 03:48 PM

Originally Posted by larch

Get pre-authorisation --> Then Authorisation --> Fill in forms needed --> Give in @ hospital and Medial Aid --> Medical Aid takes it from there. Rince and repeat for each and every procedure.

Yea you do that when your hopping around on a broken leg...be serious man.

**Tanith** · 02-02-2012, 04:04 PM

Originally Posted by Jude

Yea you do that when your hopping around on a broken leg...be serious man.

Don't be dense. He said he had his wife there with him...

All their calls are recorded Proze, you are well within your rights to request the recording. Get it and see what was discussed. They wouldn't screw you out of this if you followed the instructions of the call person.

**Tanith** · 02-02-2012, 04:06 PM

I know this because I had an argument with our insurance before, they played my recording back to me.

Turns out that I was in the wrong and that I didn't follow the steps provided. Fair is fair.