Discovery Health Medical Aid
Reviews and Complaints

Discovery is very quick when it comes to collecting debit orders... If only they were as quick in refunding monies. Submitted a claim for a refund, a discovery consultant approved it 2 weeks ago... Still the money is not in my account. If discovery is to open a retail bank.. They wont see me on their doors!

Joined 1st january was accepted in may i notify them about an operation i was going to having august refuse authorisation number because of the agents zaarik yoosub which i was told this month is as agent told him all about my pre-existing condition no waiting period his profile is not what i was told, my membership was cancelled via email can get my telephonic conversion that i had with zaarik yoosub. Please advise me what to do. Thank you.

My son is 22 months old and has been revered to Paediatrician Neurologist who recently diagnosed him with Epilepsy. She does request cash upfront which you as the member need to get back from Discovery. After a month we have still not received our refund. After 5 email and 20 phone calls they have at least processed they claim but still awaiting for payment. We were NOW also informed Discovery does not have a PAYMENT ARRRANGMENT with the doctor therefore they are only willing to refund us half our money. I as the member feel whatever arrangement they have with the doctor should have nothing to do with me as the member. That money I have in MY SAVINGS is my money the member not Discovery’s money. They would pay a normal paediatrician who does not specialise in a child’s brain R 719-00 because they have a payment arrangement with that doctor. A paediatrician neurologist which specialise in a child’s brain they are willing to refund R 489-10 according to the agreed amount. Agree amount according to whom! How does is make sense? Surety the C.E.O. of Discovery does not receive the same salary as the staff in the claims department. I even gone so far as to call discovery held on for 10 minutes asking them to refer me to a Paediatrician Neurologist they have a payment arrangement with. They came back and said they have NONE. They have no payment arrangement with any Neurologist Paediatrician what does that tell you. I expect a full refund on my money !

I really had high regards for discovery health once upon a time. Not anymore. I do hope "adrian gore" (Ceo of discovery) has time to read all the negative responses and really does something about it. I applied for a pre-authorisation position and when i went for the cognitive test in centurion branch, i noticed that certain individuals where very content with there selves, as if they new what to expect to come out, i even over heard them make a statement after the test, which clearly indicates that they hand the upper hand and was given material to give them the edge to get ahead in the process. It is really sad because when i reported this matter to the guy that was the hr representative, his response was " i will definitely take it into account" but his body language said other wise. He didn't even seem shocked at what i had reported to him, as if he was aware of this and was quit content with it. I now truly believe that discovery employs people via connection calls and clear not by there widths. There poor service comments from customer all over speaks volumes of the pathetic employees. The name discovery is a thing of the past, a name that has been dragged through the trenchers.

Dear Sir/Madam.

I find it very strange that Discovery rates for Midwives are so ridiculous low when a member chooses to go through midwives as compared to hospital rates.

On average giving birth through a hospital would easily cost more than R60 000 and discovery medical aid pays in full. But through Midwives it costs maximum R20 000 but discovery rates only refund about 20% of the costs, which is unfair because not all people prefer hospitals for birth.

I would like to urge Discovery to really consider us as well as the are loosing nothing but saving a lot of money through midwives births. I recently lost a lot of money while I pay a lot to Discovery.

i submited a claim on the 30.07.2015 and by the 06.08.2015 discovery has not refunded me the money i paid at the DR, so i decided to phone them and follow up, i was told that my invoice shows a date of 30.01.2015 and the claim was then captured under Jaunary claims meaning they will not pay the claim, i have submitted the invoice and proof of paymnet which they both reflect 30.07.2015, so why would i send them an invoice dated 30.01.2015 with proof of payment dated 30.07.2015? and again why will one submit a January claim in august cause surely it won't be paid as its a late notificatiion... then am told that i must go back to the Dr and ask her to write me another Invoice and they will try fix this, realy

Adding a Dependent.
I sent application forms in on 17 June, to date addional dependant still not. Numerous reasons. DISCOVERY DOES NOT CALL YOU TO SAY THERE IS PROBLEM. you must smell that there is problem.
THEN you got told one PROBLEM AT A TIME! So between my partner and i we have made about 12 phone call, We resolved 2 issues, 1 which was outstanding since 2006, which i was NEVER informed of, never mind that they have my current phone number.
I have been promised by 3 call operators, that they would get back to..SURPRISE no call backs.

NOW i have to get my brokers to sign a form...i NEVER HAD A BROKER!

No system in place to have your queries escalated...around and around you get sent.

Needless to say - VERY ANNOYED

I am a discovery keycare member. i pay R4700 a month for me and my family. this is the lowest plan discovery offers their benefits are not bad but limited. i was diagnosed with Graves Disease in January this year by my GP. Keycare offers an annual specialist benefit of R3000 per member. keycare does not have an endocrinologist on their specialist panel but I was given the go ahead via email from people at Discovery to go and see one at Christiaan Barnard Hospital. my GP followed procedure and applied for me to see a specialist. i went for my first specialist visit in March and I had to pay R1400 and claim back from Discovery. I did this and got an email from Discovery advising they will refund R300, I have yet to receive this refund. my second visit to the specialist was in May and I had to pay R700. i was told that Discovery would look into refunding me if I paid a shortfall of R80 that was reflecting on my account. I paid this R80 only to be told that Discovery were not going to refund me any of the monies I have spent. I have to buy medication monthly at a cost of R800 which Discovery does not cover at all. I was then told that the specialist benefit my GP applied for expired on the 22nd of July, after my first visit, but they still did not cover any of my visits. how is this acceptable? yes its the lowest plan? but its still alot of money every month that I have to pay. In march I was admitted in the emergency room for dehydration, I had to pay for the blood tests that was done in the hospital. I also received a bill a week later from the hospital for R500+ that I had to pay due to my medical aid not covering? I honestly cannot understand the point of having medical aid, to pay so much money every month and then not get cover when you need it. why bother having medical aid?

Since i joined this medical aid it has been nothing but problems. Firstly it was an ongoing back and forth situation to simply add my daughter as a dependent. I had to repeatedly call and email with regards to my daughter being added, when i eventually did get through to someone i was told that the forms could not be processed due to missing information (could they not have called or emailed to let me know, after 3 weeks) Had i not contacted them i would probably still be waiting. Then it was an issue of the forms being sent back and forth, with them asking for more info or to sign every single page.

Then after a few months i realized that i was being overcharged on my monthly bill. Then there was a dispute as to the date of activation for my daughter. I had been given 3 different dates. Once i received my updated card with my daughter already being added as a dependent i took her to my GP, only to find out afterwards that she had not yet been activated.

In March i had been rushed to the hospital with a ruptured appendix and was immediately admitted... Thinking all was well and i am covered as i used one of the Network hospitals. Now i am receiving Claims amounting to over R3 000 with a note attached stating that the claim had exceeded the amount payable.
How do i go to a Network hospital, where i am told that i am fully covered and still come out responsible for paying?
When i try to inquire all i get is attitude and no help. I WAS JUST TOLD THAT I AM RESPONSIBLE TO PAY!

I've had surgery at a Netcare hospital recently in Cape town, which was approved under the Keycare option plan I have at Discovery Health, what happened after the surgery I had it was found that I was diagnosed with TB which I wasn't aware of and needed to go on a treatment plan for the next 6 months, after which the Doctor who was treating me at that stage retired and referred me to a new specialist to continue consultation and follow up until my plan was completed. What bother's me was that no one ever explained that I needed a referral from the current treating doctor to then new Doctor, and as to me what the sensible thing would be is to transfer my already approved basket for PMB benefits to the new doctor right? Well apparently I now need to go back to my GP, get a new authorisation ref to go to the new referred doctor, and then my take the matter further. At this stage I'm sitting with unpaid bills up to R3000.00 which I'm liable for payment and being harassed on a daily basis to pay as my Medical aid just bluntly said well I needed a new approved ref, which according to me was initially for treating doctor at that stage which unfortunately retired, my Only question now is...How is this my problem now that the Approved doctor retired? after I've paid my medical aid contributions on time every month time after time? I feel like I'm being victimised in this sense. I have logged this query with them several times without any success over the past 4 months, and this is totally stressing me out!

Discovery health promises the world and excellent service, yet gives you lies and attitude. i had taken out the Keycare option due to financial reasons. 2 weeks ago i had broken my foot, been to the Network facilities registered on discovery, firstly when you get to the hospitals you are treated like dirt because you belong to a low scheme as they refer to it as.
up to now after numerous calls to discovery health and visits to the hospital, i have not yet seen an Orthopedic surgeon, and been given the run around by the medical aid to get a simple authorization number. in this 2 weeks, my foot has still remained swollen, and there is bruising. but i cannot seem to get any help from either the hospital or discovery.

discovery consultants also has the nerve to tell me that, i belong to the keycare option and i should not expect excellent service.

Discovery billed me R774.00 for early termination of medical scheme of their Brother company LA Health.. I paid said amount as an agreement with Charlotte Roslind, I paid amount and still got demand letters, after contacting discovery again i spoke to Mr. Amir K who said he would look into my case as he sees no payment at all.. I have since not heard anything from the medical aid, I have been listed by this company and it is affecting my credit score.. I have proof of payment which I provided Mr. Amir with, I have been holding to speak with someone who can help me for over 30 mins now, am still holding whilst typing out this complaint. Please take me off ITC whilst you are investigating this.

Good day,

I'd like to start off by explaining my personal situation. I am a single mother of a 4 year old son. I stay with my parents as i cannot afford to live alone. My son’s father does not pay maintenance on my son. Understandably I do not have the funds to pay excessive amount due to medical aids being incompetent.

Firstly I would like to draw your attention to an instance in June/July 2014. I was placed on a waiting period for chronic conditional bipolar disorder. During this period I paid all my medicine out of pocket. Being an acute sufferer of depression I had a nervous melt down due to ongoing financial pressure. I tried committing suicide and was admitted to Palm Tree Clinic in Cape Town. Discovery refused to authorize the hospitalization as I was on a waiting period. The treating psychiatrist (Dr K Moodliar) made various attempts to stress that I needed the treatment urgently and explained the severity of my condition. I was 2 months away from being off my waiting period still Discovery refused and offered not alternative or help regarding my treatment. Consequently I paid the entire two week stay, medicine and doctors’ bills out of pocket. I am still paying back these bills after I went into a payment arrangement with the various suppliers. These bills together will probably amount to well over R 30 000.00

On the 2nd of December 2014 after having waited a year and paying all medication out of pocket I sent through me chronic application for Bipolar. After various telecoms to Discovery I was informed that they would only cover a slight portion of medication needed. I take Aspen Trazadone 100mg nocte and Venlor 300mg in the morning. My first application was rejected as the doctor did not include epitec into her treatment base. My second application was approved for Trazadone but not for Venlor as they are apparently both an anti-depressant. I tried to explain to Discovery that I understand their formulary lists but combing all patients under the same rule seems somewhat unfair. My medication is over R 1200.00 per month. This may seem like a small amount but taking that, together with the fact that i pay full medical aid and I am a single mom... The explanation was given that Discovery does not pay for Serotonin–or epinephrine reuptake inhibitors which would therefore mean that all patients suffering from Bipolar Disorder have to be on the same medicine even though it has no effect on their emotional wellbeing. I have had depression for numerous years and psychiatrists have tried various combinations of medication but I never relieved the symptoms. When they however found the combination that improves my emotional state Discovery was not willing to review full payment of these medicines. I therefore still pay my chronic medication out of pocket and this has, in the last 14 months costed me a minimum of R 20 000.00 already. The doctors have now put my on sleeping tablets as well but i dread sending this application through as I know that they will have an excuse not to pay this too.

On the 9th of February 2015 I Contacted discovery regarding authorization for spinal surgery. As per the specialists notes on the MRI and X-rays there is a severe instability on levels C5+C6. An authorization number was given but I was informed of a co-payment to the hospital of R 11 550.00. I do not think they fully realize the severity of this situation. I contacted them various times on the 10th of February 2015 to get clarity and to request if they would not please review. Again, they offered no solution to the problem. I switched over to a higher plan as to ensure we (my son and I) have more comprehensive cover should we need it. I told them over the phone that i was not aware of the fact that there would be such a large co-payment on spinal surgery as i would not have moved over to that plan if I knew. I broke my neck in a vehicle accident eight years ago and have a fusion on levels C4+C5. I therefore thought that i needed good cover for spinal should something go wrong at some stage. I would therefore not have made the decision to move over to this plan type considering the injuries sustained. As per Discoveries explanation, they are not financial advisers which I understand but surely they should inform members of the pros and cons of moving to different plans. I am now in a predicament as the doctor explained this is very urgent surgery (as he classified this as severe instability) but do not have the funds to pay for this. I have had to cancel my operation and am now running the risk that should I sustain any neck injury, I will be paralyzed.

I wish to draw your attention to the Bill of Rights of South Africa.
Section 11 states: "Every person has the right to life" - the full meaning of the word life is: "the condition that distinguishes animals and plants from inorganic matter, including the capacity for growth, reproduction, functional activity, and continual change preceding death."
a) Refusing to cover my entire hospitalizations for my neck is taking away my right to functional activity as I am restricted in my personal and professional life due to the fact that I do not have access to the full use of my neck.
b) Refusal to pay my admission for bipolar when it was a clear medical emergency as per section 27.3 of the constitutional act almost cost me my life.

Section 12.2.B&C "(2) Everyone has the right to bodily and psychological integrity, which includes the right-
(b) to security in and control over their body;
- Placing patients under a formulary law that states/indicated all patients with a certain condition need to take certain medicine is taking away the patients control over their own body
- Refusing to fully pay my hospital admission for my neck fusion will eventually cause me to lose control over my body as my neck's condition degenerates daily. Should I sustain an injury at this point the chances of losing function of the rest of my body are 99.9%.
And
(c) Not to be subjected to medical or scientific experiments without their informed consent."
- By refusal to cover chronic condition medication in full, I am being subjected to their experiments as I am forced to take medication in their formulary lists of pay my medication out of pocket which I can truly not afford.

Certain professionals in our country have a responsibility to aid in the bettering of the nation’s health. Discovery Health has however not just on one occasion put my life at risk with their absolute nonchalant attitude towards their clients. Being a health and safety practitioner (in construction) myself, I know that when people's lives are stake, you need to go the extra mile to ensure they are safe and healthy. I also know that you cannot treat people in a way that could cause harm or injury as per the OHS act. Compassion is key in this industry and without this you merely function as an organization that is out for people's money. Further to that they have not only placed me at risk numerous times but have over and above what I can afford made sure that they are covered as not to pay claims. I feel exploited and they have gone beyond all means to ensure I do not receive the medical care i need.

There has been an irreparable breakdown in relationship between myself and Discovery Health. I have lost all trust and belief that they are able to provide in my healthcare needs and that they have my sons and my health as a priority.

Could you please provide guidance on how this matter can be resolved as I cannot allow this any further?

When I was booked in for delivery in November 2013, the hospital/discovery had an incorrect authorisation code ( due to a system error ) and by the time they needed to correct the error the self-payment gap was already closed and now I become responsible for the R700.

So if I understand correctly I now have to take responsibility for your system errors? I’m not sure I signed up for that one… When I booked for delivery my understanding is that everything that is done in hospital will fall under my hospital plan ( where does the self-payment gap come in – I’m not consulting a specialist, gp or rendering any service that requires anything to do with my medical savings)

This is not fair seriously not fair

I assisted my dad to get onto a medical aid. So we contacted discovery. It was an absolute nightmare to get him approved as we had to keep on sending the forms back and forth for 'new' information they needed because he is 60 and has not been on a medical aid for 25 years. Then he gets an ear infection and then they delay the authorization because they say 'they need a full report from the doctor because he recently just joined. This was mid august. The question I ask is why would he have kept the middle ear infection for two months and then only tried to claim for it. It's an infection which is common. Finally the authorization gets sent, he goes to a specialist and then again we must send the forms back and forth for information they need. My dad does not work so he has to keep on going somewhere to have this sent off. My dad also had to pay cash to the specialist for whatever reason. Even though they gave authorization for it! It is shocking! Then you speak to staff who are so rude! Unacceptable

Re: Waiting period

Last year december on the day my husbands work closed for holidays, they gave him a permanent contract, that include us going on discovery medical aid at that time we were on medihelp and i was pregnant due in Januarie. we phoned discovery and asked them what we should do go over to them or stay on our medical aid, and discovery advised us to rather stay on medihelp till after baby was born because the would not cover the delivery costs. unfortanately my baby ended up in the NICU and then 3 times after that admitted in hospital until the peads put her on monti- air that is for ashma patients. Medihelp then said we should stay on for six months we suppose it was because of all the hospital costs. long story short we ended our medical aid with medihelp en of june and we were on discovery beginning july they then gave us a waiting period of 3 months each and a 12 month for my baby not to get bronchilitis, any lung infections ect i told them they cant do that they then removed the 12 months but left the 3 months because of my husband and daughter being on chronic medication. that apparently makes them high risk. in all respect i understand that we can have n waiting period were we are not allowed to go to the dr or specialist or do procedures, but my problem comes in when if my daughter gets admitted in hospital coz she is so small with brochilitis or my son or we get in to a car accident they must atleast cover the hopspital after all we are paying them for that service, and all they say is No only if its life threatning.

I'm really disgusted that the company I work for, forces me to use Discovery health. Over the past 2 and a half years, I've spent upwards of 17 000 on a terrible plan that increases it's price every year, and decreases it's benefits. I have not been to the gp once because it's a nightmare to find a keycare gp close by that doesn't seem to be a sham. I became really ill a a while ago and needed to go to the gp's i'd chosen according to my plan. Except, upon trying to secure an appointment- both gp's phones were not being answered. Infant, upon trying to Google these gp's based on their names and locations, neither yielded any medical practitioner database results. In this day and age, how are gp's not listed anywhere? I phoned discover for help. The first consultant hung up realising these gp's didn't exist. I once again had to pay mt regular gp out of pocket to help me
When I complained on the discover Facebook page, someone got hold of me a few days later and apolagised having tried to contact the gp's. She said that maybe they had moved. Sure
She said she would send me a list with all gp's In my area but never did. I hate discovery. I don't want anything to do with this company.

I realised it was 6 months and I have not received my savings claim since I cancelled my membership. I called discovery on the 17th June and they explained that my money was paid to my old account and rejected.I submitted new form and all information required.I called after a day to make sure all documents were correct and the consultant said all is in order and my money would be pain by latest 25th June. On the day i received an sms to say the details were not correct.I was furious as i followed up to confirm.I re submitted the documents again and i still have not heard anyhing.The consultants were friendly but my problem was still not solved and no one has been in contact with me again . The lady who initially helped me went on leave and the guy told me that it was her problem to deal with and i will have to submit the forms again due to other account number
being incorrect.I received the confirmation letter from the bank and the letters are structured so that their are 3 zero's after the account number.Surely you guys have many clients with standard bank and could confirm this with the bank.I am very annoyed as this is taking way to long to solve and has been an inconvenience to me.I would appreciate if someone could sort this out asap. My name is Nadia Gool. membership number is [protected]

I am unable to gain hospital authorisation for a DD&C procedure, to be performed tomorrow morning. I have been trying to request authorisation from Discovery since Monday, and they have now informed me, that my hospital and anaesthetist will not be covered. So in fact that are covering nothing! I have been a part of Discover since April 2009, and not once been admitted to hospital or requested any form of procedure. My first procedure, wish is not a happy experience, has been denied and now i either have to cancel it tomorrow, or what? I am so disappointed, over 5 years i have paid them over R150 000 in premiums and still get nothing in return.