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Discovery Health Medical Aid / medical aid - keycare plus

1 South Africa

I came to the conclusion that discovery health medical aid is just like any other insurance company. You pay your premiums and agree to the terms and when it comes to the point that there is a claim then they decline it and will have several unrelated reasons why they are not paying. Im so frustrated, disappointed, angry and dispirited. Im starting to regret to have joined this group.
I completed the application process on the 1st of october 2018 and at the time had no medical issues, except for hypertension and I have informed them of that. I was given a 3 month waiting period that expired end january 2019. On the 12th of november (a month and half after completing the application) I fell ill. Went to the doctor, saw 2 specialists, ended up in hospital, had a ct scan and ultrasound done, blood tests, colonoscopy and gastroscopy and eventually I was diagnosed with a kidney stone and secondly with liver cancer.
Wow, what a blow and surprise that was. I had a kidney procedure done where a "jj stent" was placed from the kidney to the bladder. I have informed every medical practitioner that im in my waiting period and would they mind providing a report if its requested by discovery health medical aid.
I have paid for all the consultations, tests, hospitalization, procedures and medication in full. Roughly an amount of r44000-00.

The urologist suggested that the stent and stone must be removed by middle february and the other specialist wanted to wait to do an biopsy on the liver. The biopsy could tell if the cancer can be removed or if I have to undergo chemo therapy. Nothing was done to date related the liver as the kidney issue is to be "sorted" first.

When I did the application I was told that I must inform discovery of any health changes during the waiting period. I did so, in advance before the waiting period would expire. I provided doctors names, dates, procedures and full information regarding my health change.

My issue with discovery now is that I have consulted a doctor in the network on the 1st of february who the have requested pre-authorization to refer me to a network urologist and it was declined. Discovery also have declined the gp his claim for the consultation.

Please correct me if I am wrong but I was supposed to enjoy full benefits according to the plan I have joined as from the 1st of february 2019. I have agreed to the 3 month waiting period with no cover, not even emergency assistance in that time and I have paid 4 premiums to date and still have no cover. Why does discovery not pay the gp? You take my money and deny me the benefits we had agreed on in a contract. I want service!


Feb 8, 2019

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