1 reviews | Active since Nov 2016

23 Aug 2017, 11:59

Broken promises.....time and time again

I app**** for hospital treatments to be done and it was approved for 12 out of 16 treatments at 100% discovery rates. We provided the dates for these treatments as it is standard protocol for the structure of the treatments to me most effective.

I started doing the treatments as I was under the impression and according to my approval email received, that I will only have co-payments for the amounts claimed that was above discovery's rate. Which is fine as I know the doctors have advised me that most of their items are below this rate.

Now whilst I'm busy doing the treatments I am receiving my daily claim emails from discovery for these treatments, with items not being covered for reasons;

CODE 6 Your Plan excludes cover for this claim - we have not paid it. (But how was it then approved?) CODE 258 This claim line has been rejected/part paid since the frequency/quantity allowable on this code has been exceeded. (amount and dates of treatments sent through with initial claim) CODE 210 You have exceeded the quarterly or yearly limit for chronic medicine or treatment. You are responsible to pay this amount. (amount and dates of treatments sent through with initial claim)

Now I've called discovery a couple of times trying to rectify these claims. Please check my call records as your calls are recorded. I cannot understand how there is an excuse now regarding the frequency and yearly limit, as we have sent through the dates of treatments initially when we claimed and had it approved.

I have been promised three times now for a call back with a solution or explanation and have not received any response for over a month now.

I cannot stop these treatments now as the structure is protocol and is vital to the success of the treatments, as been proven overseas. It just seems nobody cares at discovery to help me.

Can someone please call me to resolve this matter.

0
Replies (2)
Discovery Health
Discovery Health's reply23 Aug 2017, 14:31
Official

Dear jessica-burke

Your concerns are important to us and we will be in touch soon with an answer to your comments.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply25 Aug 2017, 12:42
Official

Dear jessica-burke

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

Regards
Discovery Health Servicing Team