Discovery Health: 3 - Alex Eliseev: 0

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...

Horned Terror and Discovery D-Day

"Sibongile Mnisi was sitting in front of her house, eating pap and meat. Then a goat came out of the bush... Some who were there say the crazy creature charged up to Sibongile - and plunged its horns into her chest! Screaming children threw rocks at the horned terror and it ran off... but it was much too late for Sibongile."
Yes, this is from the latest Daily Sun. Yes, I promise I won't make this a habit. But "horned terror"... how could I resist?
Hell of a day yesterday. The Hawks (our new crime-busters) bungled the announcement of their first breakthrough and have now been credited with the arrest of two low-life robbers and their sangoma (witch doctor) down in Kwazulu-Natal. Some spokesperson got a little too enthusiastic about the foiled jewellery store hit... but forgot to give the Hawks a heads up.
I also covered the start of the Razor Gang trial in Alexandra. The actual trial was postponed to today but it was fun watching some other suspect being carried up to court from the cells by four policemen. Apparently the magistrate has such a fierce reputation in the township that the suspected robber didn't want to face him in court. (The same magistrate who sent the leader of the Knife Gang to jail for 40 years.) This guy kicked and screamed all the way up to the dock and had to be held down like a wild animal while the magistrate read him his rights.
Today is D-Day for the matter of Alex Eliseev VS Discovery Health. For most of this year I have been fighting for them to pay for a set of scans I need to have done. They have, so far, politely told me to go to hell. The irony is that if I check into hospital (which costs them R20 000 / R30 000?) they will cover the scans. If I do it out of hospital, it costs them R4 600. And this is the amount they are refusing to pay. So this evening I have a dispute hearing where I will state my case to a panel of three of their doctors. The medical aid will respond and there will be a ruling.
My consumer battles have included: a fight to get my cellphone provider to pay me back for a string of calls made by the burglar who cleaned out our house a few years ago (to his friends in Nigeria); to challenge the hike in insurance premiums on my car; and to make my bank sorry for freezing all my accounts (leaving me with R5) because of their own bungles. All of these I have won, but this one is definitely my longest and most complex battle. Just as well I have the energy of 70 000 toyi-toying construction workers!