JK
Jaco K

1 reviews | Active since Aug 2015

04 Nov 2024, 10:45

Claim unpaid without valid reason - UDPATED

I submitted a claim for a medical device on 9 September 2024. According to my health plan this device should be covered by Discovery and is well within the allowed claim amount as per my policy. At first the claim was rejected because apparently I already claimed for this device in the last 3 years, even though I never claimed for anything. Then Discovery asked me for ICD-10 codes that was added to the invoice on the medical device that was purchased. I emailed the updated invoice with ICD-10 codes to *********** on 9 October, as per request from the first agent I spoke to. Subsequently, I have now spoken to 4 different agents at Discovery that keep on telling me they can't see any reason why the claim is not being paid and they assure me they will get back to me within 2-3 days. This has been ongoing for more than a month now. The 2nd last agent (Jesse) that I spoke to on 21 October again promised they will come back to me within 2-3 working days. I phoned again on 28 October only to be told 'we are waiting on ICD-10 codes' that was sent to them on 9 October. The last agent I spoke to told me to please hold on and then they cut me off. Never bothering to phone me back either. I posted on HelloPeter on 28 October and was contacted by Discovery. They said that the invoice needed an ID number or membership number (even though this was the first I heard of this after more than a month trying to get this sorted). I was assured that the invoice was updated by the the vendor that sold the item and that someone will contact me within a day (or worse case the claim will be processed within 2-3 days). Again, I have not heard anything back from Discovery. My experience with Discovery is just getting worse and worse. I was forced to move from another Medical Aid provider, and never had this level of trouble getting feedback on a claim. I am not sure what level of service Discovery Health reckon is acceptable but this is getting more and more ridiculous by the day. I will give this another week...then I am forced to look for alternative ways (e.g. Medical Aid Ombudsman) to try and get this resolved.

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Replies (1)
Discovery Health
Discovery Health's reply04 Nov 2024, 11:07
Official
Dear Jaco

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