JC
Justice C

1 reviews | Active since Aug 2016

25 Jan 2021, 15:12

Claims declined

Hello friends on discovery medical aid scheme, and those who left. I am one of them on Essential Saver with benefits such as 4 network GP visits when out of MSA(Medical aid Savings Account) funds. Guess what: I went for a consultation with a network GP using funds available in my Medical Aid Servings account in late 2020. When I realized my condition was getting worse after a few weeks I went to the same GP to have a review of my condition. When the GP submitted a claim for my review Discovery declined the claim saying I should have gone through a Pharmacy clinic and get a referral from a Pharmacy nurse for my follow-up consultation with a network GP to be approved --- I find it difficult to understand. I called 2 consultants they can only say that's what the policy says. Nowhere in their huge documents is it written that even if it's a follow-up consultation you go through a referral. Why would someone have to go through a Pharmacy clinic for a follow-up consultation with a network GP? ridiculous.

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Replies (2)
Discovery Health
Discovery Health's reply26 Jan 2021, 07:13
Official
Dear Justice C

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

Discovery Health
Discovery Health's reply26 Jan 2021, 12:38
Official
Dear Justice C

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

Regards Discovery Health Servicing Team