My mum a 64 year old pensioner, was admitted to hospital on the 03/05/2013 . We were told that the authorisation was received. 5.5 days into her stay, we are informed that, sorry it was declined and the member is now liable for payment of the account. Upon enquiry, we were told that her condition is an exclusion on her plan. She was admitted in an emergency situation because her vein burst and she was bleeding profusely. I have written to the MRC and I have seen the response from Discovery which I am not happy with. It states the REMOVAL OF VARICOSE VEINS is an exclusion but she was not admitted to remove her vein She was admitted because the vein bled.
I can understand if the procedure the surgeon prescribed is an exclusion but she was not admitted to have the procedure done.
My question is why was she admitted in the first place if medical aid is going to decline the payment?
Why were the family informed 5.5 days later that discovery will not pay. Surely the case manager should have intervened!?
If a person is admitted for septicaemia caused by cosmetic surgery, will they not be treated for septiceamia even if cosmetic surgery is an exclusion?
0 comments