KB
Kevin B

1 reviews | Active since Jul 2009

25 Aug 2015, 06:54

Claim Not Paid

I had cataract surgery on both my eyes,paid for by Discovery.I was given scripts for two bottles of eye drops for each eye which I paid for.I was advised that if I completed an Out of Hospital PMB form and paid the doctor R560 to sign it that Discovery would pay the eye drops and the consultation fee (I only have a Hospital Plan)I confirmed this with Discovery who subsequently paid the consultation fee and authorised one bottle of eye drops which to date I have not been reimbursed for despite many emails and calls.This begs the question:If they are willing to pay for one bottle of drops, what am I supposed to use on the other eye?Also, why not all the drops as I was promised when confirming the PMB Form? I have on many occasions called and emailed to be told that this matter would be resolved within 3-5 days but to date NOTHING has happened!!

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Replies (1)
Discovery Health
Discovery Health's reply01 Sept 2015, 10:03
Official
Hello KBethlehem,

Thank you for your comment.

The Medical Scheme's Act allows Schemes to apply a medication formulary when reviewing funding for PMB and treatment requested is reviewed based on the information received. As a result part of your request was reviewed and approved.

This was since retrospectively review and treatment was approved accordingly and we have requested for claims to be processed in accordance to the approval.

Regards
Meryl