tT
tumbler T

1 reviews | Active since May 2017

11 Jan 2019, 10:46

Claim rejected twice despite PMB letter of approval.

I had a prescribed minimum benefit approved for 12 sessions with a psychologist. I put the claim in for several of these sessions. I had to claim for each session separately. I attached the PMB approval letter after which I got a call asking me why I did that. I did it so that the people managing the claim would not try to deduct the amount from medical savings. One of the 7 claims was denied despite the PMB being approved. I called Discovery to notify them of the problem, and the lady was very apologetic and said that I was correct that the claim should have been paid nas I had an approved PMB. She told me to resubmit my claim. I have now received notificatioon that the claim has ONCE AGAIN been rejected because my medical saving for 2018 was depleted. IT IS A N APPROVED PMB!!! How do I get that across to your staff that clearly do not know how the system works?

I am currently waiting on the line for a "s****ed consultant" to answer the phone. PS. Discovery, your automatic telephonic referral system has no option of "they ******ed up my claim and I need to speak to a human not a machine".

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Replies (2)
Discovery Health
Discovery Health's reply11 Jan 2019, 12:24
Official
Dear  helen-strachan 

We’re sorry to hear you’re dissatisfied. Please give us a chance to look into your query and we’ll be in touch soon.

Regards
Discovery Health Servicing Team 
tT
tumbler T's update13 Feb 2019, 09:02
Reviewer Update
Discovery contacted me to say that a different code needs to be used. They said that I am entitled to the claim being paid out, but that the invoice needs to be ammended. I contacted the Doctor's rooms' secretary and she said she was unsure which code Discovery want her to change the invoice to. I then sent an email to Dayne Meyer to ask for assistance with telling me which code the lady needs to change the invoice to. I have not yet received a response to the email that was sent on 21 January 2019.