Discovery Medical Aid Logic Failure

[Update: WOW – A response from Discovery in under 30 minutes! – Colour me impressed! The issue is not solved per se but at least someone is looking into it. Cudos to Discovery]

While I am by no means a fan of medical aids in general I have been genuinely happy with Discovery – even to the point of having recommending it to numerous (I’d guess 40+) people over the course of 13 years.

Today however made me realise its time to re-evaluate a medical aid based rather on the intelligence of their systems than simply on ‘general hassle free’ aspects. No question Discovery generally falls into the category of ‘smart’ when it comes to how they handle risk, claims and their customer base – but sometimes they can be downright stupid. Today being a prime example:

My youngest is on long-term medication – Pedicol – which is supplied in boxes of 20 sachets. While the doctor indicated we can and should use more than 1 dose a day if required, we have been able to stick to a single sachet a day … so this should last us 20 days…. Logic would dictate that a responsible parent would go and get a refill BEFORE it runs out…. i.e. just before the 20 days. I tried to do so today…..

Not so reckons Discovery. They have applied a rule on their system for no more than 30 sachets in any 23 day cycle. Well, not a problem most of you would say… You only used 20 in 20 days. Using their 30 in 23 days ratio I’d be able to collect 20 sachets ever 15.3 days …. Too bad the ability for Discovery to perform elementary math is flawed…..

In their infinite wisdom they determined that I cannot yet collect said medicines after 20 days…. as its less than the 23 day minimum.

It is moments like this where I my frustration with broken mindsets bleeds through. Surely this should be a simple application of a standardised ratio — not to mention the fact that based on the Doctor’s advice and input from the pharmacist working on a single sachet per day is the absolute minimum typical recommended in cases where Pedicol is prescribed. So not only do I pay Discovery for the privilege of their services – I now apparently pay them for knowing better than my qualified Doctor and Pharmacist….

Suddenly I understand why a number of Doctors are less than impressed with HealthID – talk about an actuary controlling your medical ‘best interests’.

Does this mean I’ll leave Discovery — of course not — overall I’m still impressed with their offering and ability to make the pain of a ‘grudge purchase’ more bearable.

Now to try and get a single Discovery employee to pay sufficient attention to the problem so it can be addressed and fixed……

[P.S. I was attempting to perform this miracle of logic at a Dischem store – so I hope my frustration is aimed at the right software dev team 😉 ]





Permanent link to this article: