Discovery Health
Criteria not met for isolation in hospital

My wife was admitted to hospital after her second visit to the outpatient section with severe abdominal problems. After being admitted the doctor had her moved to an isolation ward in fear that my wife's condition could be contagious to other patients in the hospital and the staff treating her. The additional cost for the 2 nights in isolation was R1116.00.

Discovery have refused to cover this cost on the following basis: "clinical criteria for isolation ward was not met".

The ridiculous issue here is that I am supposed to know that I must get further authorisation for every decision the doctor and hospital make even though my wife was admitted with approval from Discovery. After being notified of the declining of the isolation cost, I went to the doctors consulting rooms with all the correspondence of the refusal of the claim. The doctor wrote a separate report and sent it to Discovery, who again refused the claim.

I am not a doctor and who am I to challenge a hospital and doctors decision on the diagnosis. My wife's condition was very severe and I'm grateful for the treatment she received because she responded to the treatment administered to her.

Discovery refuses to pay

Company: Discovery Health
Country: South Africa
City: Johannesburg

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