Discovery: In-room procedures (2027)

Some procedures can be done in your specialist’s rooms instead of in hospital. If the procedure is on Discovery’s approved list below, it pays from your Hospital Benefit. It does not use up your day-to-day benefits, even though you are not admitted to hospital.

This applies only if your specialist decides the procedure can safely be done in their rooms and Discovery has approved it. Cover is subject to Discovery’s clinical entry criteria, treatment guidelines and protocols.

Before your procedure

You must preauthorise the procedure with Discovery as soon as it is scheduled, even though it is done in the doctor’s rooms. For a planned procedure, call Discovery at least 48 hours beforehand. They will confirm your cover and explain how your accounts will be paid.

On KeyCare plans, you also need a referral to the specialist from your nominated KeyCare GP.

How Discovery pays

Discovery pays the specialist’s account from your Hospital Benefit up to the agreed rate for your plan (on KeyCare, up to the Discovery Health Rate). If Discovery has a payment arrangement with your specialist, the account is paid in full. If not, the specialist may charge more than Discovery pays, and you will have to pay the difference.

Discovery also pays related accounts approved as part of the procedure, such as the anaesthetist’s account and pathology (lab) tests. The rate paid for these depends on your plan.

Scopes done in rooms: gastroscopies and colonoscopies done in rooms are covered separately. No co-payment applies if the scope is done by an in-rooms network provider. If you use a provider outside the network, a co-payment may apply, depending on your plan.

You can find your plan’s full benefits here.

Approved in-room procedures