To avoid paying me R4 600, Discovery Health convened a "dispute hearing" last night for which they hired a 3-member panel of medical experts to, basically, tell me to go to hell. The hearing, which included the panel, snacks, coffee, two Discovery legal and medical experts (to fight off my claim), a friendly convener and even an intern which came to listen, must have cost them a fortune. At the end, my only victory was taking home a bottle of still water (paid for by Discovery) and letting my friends sip away a tiny fraction of the company's profits. "Evil capitalists!" I mumbled as each friend took a turn. But let me explain...After three months of fighting over the R4 600 I needed for a couple of CT scans (headache related) I had reached the final frontier: the dispute hearing. My gripe was that Discovery wanted me to pay R3 600 of the amount while they would pick up the balance. This would bankrupt my savings for the entire year and force me to pay in money - which I considered to be grossly unjust. Yes, I knew that my policy had limitations. But, I figured, after being a loyal client for five years and having paid them over R70 000 in premiums, surely they could make an exception.
I waited to call their bluff, thinking they would decide it was not worth the fight. They waited for me to fold, reckoning I would get tired of the battle. Last night we finally met, in conference room 8 at the Discovery head quarters in Sandton.
The hearing was very much like a court case. I stated my case and told them that my health should trump their fine print. I went in to try and appeal to their common sense and humanity. They hit back. "With all due respect... blah... blah... the rules state... blah... the member signed this... blah... blah... he is bound to it... blah... technicality... technicality... technicality..."
There was cross-examination, discussion and then we were sent out of the room while the panel deliberated. The "independent" panel consisted of: an advanced-life-support paramedic, a lawyer and a trauma doctor. Each one had to be "remunerated" and the Discovery staff were also probably paid overtime. And there we were, waiting for the verdict. As we chatted, I was told about another dispute where a man wanted Discovery to pay R350 000 worth of dental work. Now there was a real dispute, I thought.
About 10 minutes later, we were called in and I was told that rules were rules. Sorry. We had a brief off-the-record chat and I was sent to do the walk of shame through the now-empty Discovery building. The tribe had spoken. Goliath had won. But even so, I felt pretty good about having stood my ground...
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A Johannesburg hospital refused to formally admit my father as an emergency ICU patient until my distraught mother had obtained an authorisation number from Discovery, which required explaining what was wrong with him -- a bit difficult when he could not be examined by a doctor until Discovery gave the go-ahead. In the end the nurses took what can only have been a wild, flying stab in the dark and came up with a Discovery-acceptable reason.
ReplyDeleteSee you in the gym? At the movies, perhaps?
Ouch! Medical aids are a big rip-off - I think. I was once a member of Discovery and it was NOT a happy marriage at all. It ended in tears.
ReplyDeleteThink how exciting it will be when you have to fight off the National Health Insurer instead of Discovery...
ReplyDelete... Take your experience and throw in Government officials.... Cold shiver...
Discovery is a great scheme.
ReplyDeleteUntil you have a claim, especially in an emergency.
When my mother had a stroke and needed emergency treatment, I "discovered" what a good medical aid isn't.