Will Discovery Pay for a Colonoscopy?

What is a colonoscopy?

Colonoscopies are generally used to screen patients for colon cancer but may also be administered for other reasons. Using a long, flexible tube with a camera and light source at its tip, a doctor can look at the inner lining of the large intestine or colon. A colonoscopy can help to detect early stages of colon cancer by identifying problematic polyps or tumours.

How does Discovery covers investigative procedures such as colonoscopies?

Importantly, Discovery covers endoscopies, which include various scopes used to investigate the digestive system (including colonoscopy). But the cover differs depending on the patient’s particular plan.

Colonoscopy Variations

If a scope is done in hospital:

  • An upfront payment may apply to the hospital account (depending on the plan) and
  • All accounts related to the procedure will be covered from the Hospital Benefit (subject to approvals) according to the plan

 

Colonoscopy and Your Medical AidIf a scope is done as an outpatient (i.e. at a doctor’s rooms):

  • An upfront payment does not apply and
  • Discovery will generally pay without using a member’s day-to-day benefits

 

All scopes require authorisation at least 48 hours before they are performed.

Specific Cover by Plan

The table below outlines specific cover for a scope for each particular Discovery medical aid plan.

 

Plan In hospital Out of hospital
Executive Hospital account covered in full

Related accounts covered from funds in Medical Savings Account/Above Threshold Benefit

Related accounts covered from funds in Medical Savings Account/Above Threshold Benefit
Comprehensive Pay first R3400 of hospital account from day-to-day benefits

Balance of hospital account paid from Hospital Benefit

No limit applies to these services

Claims paid from Hospital Benefit, up to 100% of Discovery Health Rate

Priority Series Member pays first R3900 of hospital account

Discovery pays balance (including related accounts) from Hospital Benefit

No limit applies to these services

Claims paid from Hospital Benefit, up to 100% of Discovery Health Rate

Saver Series Discovery pays first R4200from available funds in Medical Savings Account

Balance of hospital account paid from Hospital Benefit

No limit applies to these services

Claims paid from Hospital Benefit, up to 100% of Discovery Health Rate

Smart Plan Member pays first R4200 of hospital account

Discovery pays balance (including related accounts) from Hospital Benefit

No limit applies to these services

Claims paid from Hospital Benefit, up to 100% of Discovery Health Rate

Core Series Member pays first R4200 of hospital account

Discovery pays balance (including related accounts) from Hospital Benefit

No limit applies to these services

Claims paid from Hospital Benefit, up to 100% of Discovery Health Rate

KeyCare Series Scope covered in Discovery network of day-case facilities only

All accounts covered from Hospital Benefit

All accounts paid from Hospital Benefit, up to 100% of Discovery Health Rate