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natassia R

1 reviews | Active since Oct 2015

28 Sept 2020, 10:51

Anglo MS medical aid Scheme (Discovery Health Administrator) pays only R700 of R10799 of Emergency root canal treatment.

Good day Discovery Health Medical aid (Anglo MS) is my employers medical aid service provider (Anglo American). I had an emergency root canal treatment done on the 15 Sept 2020 and it cost me R10 799. I sent the claim to medical aid (Anglo MS- standard care plan) and I spoke to call centre today and they advised that the Dental risk dept will only pay R700 to me based on dentist not being part of their network. I'm so frustrated and angry because surely the analysis of claim should also look at the emergency and extent of treatment?? not just network policy.....nonetheless I will be recommending to my employer, Anglo American about this and will complain about this claim and the service i've received from Discovery Health as the administrator of this Anglo MS scheme. I want to escalate this to the Discovery Health claims dept to re-review my claim and provide feedback. regards Natassia Ramkishwar

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Replies (3)
Discovery Health
Discovery Health's reply29 Sept 2020, 07:58
Official
Dear natassia
 
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 
 
Regards 
Discovery Health Servicing Team
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natassia R's update30 Sept 2020, 09:56
Reviewer Update
Hi everyone and Hello Peter community...Update today from a Jareth Booth, 30 Sept 2020 and the consultant advised that Discovery will not further review or change their position on this as my dentist was not on their normal network service provider...what nonsense!!! this was not a normal treatment but an emergency treatment hence case should be dealt with as an emergency procedure and not normal day to day benefits....Discovery has recommended i fill out a ex-gratia form, submit bank statements and clinical reports for a root canal for the committee to review ONLY AT THE END OF THE YEAR....Again ridiculous!!!!!!!!!!!! I am seriously unhappy, i have discovery policies and will be moving my business elsewhere ......I will be sharing this on all social media platforms so consumers can be aware of this....
Discovery Health
Discovery Health's reply30 Sept 2020, 14:15
Official
Dear Natassia

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team