ZL
Zandile L

1 reviews | Active since Nov 2012

06 Feb 2015, 09:33

***

I am so frustrated, i have been through several call centre agents and I am still to receive help. I sent through a reverse claim a while ago and it has still not processed even now. I called the call centre explaining my predicament for the first time and before the amount of R1440.72 was paid to the doctor and he promised to sort it out and that he will call me back and he never did. The claim was processed and paid to the doctor and then i called in again to get it reversed and i was told to fill in a form and fax it through, i did as instructed only to get an email saying it is not clear again, no call was made to this effect. I had to call the call centre again to get an email address to email it to and I managed to email the reverse claim on the 04 Feb 15 and I received an email from discovery #*** that someone is processing it and will call should there be any problems, only to call again today to be told that the reverse claim has not been processed and the consultant said she will only put the claim through today and it will take another 3 to 4 working days, I feel this is unfair as the consultants that i have been dealing with did not do anything about it .

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Replies (1)
Discovery Health
Discovery Health's reply10 Feb 2015, 10:20
Official
Hello Zamar,

Thank you for your comment.

Should the Scheme receive an eligible claim from a healthcare provider, we will process this claim within 3 working days. The Medical Schemes Act states that all valid claims needs to be processed within 30 days of receiving it. If you do not wish to have this claim processed on your membership, we do require a claim reversal form to be completed as there are terms and conditions that apply.

As discussed the claim in question has been reversed as per your request. Please accept my sincerest apologies for the manner in which your query was handled. I have addressed this internally to ensure that this will not occur again.

Thank you for allowing me to assist with your query.

Kind regards
Jashvir