Constantly having to fight to get anything paid out from Discovery

<p>I recently changed jobs and was thus required to move medical aids as I was previously on a closed scheme and had to leave it when I resigned.</p> <p> </p> <p>The new company I joined mostly did Discovery and been with Discovery a few years ago I decided to move back to them. I'm slowly but surely starting to regret every moment of that.</p> <p> </p> <p>I sent in my Discovery forms in May and cover was to start 1 June 2017</p> <p> </p> <p>On the 5th of June our baby girl got really sick, we took her to the doctor who said she needed to be taken to hospital to be admitted. On arrival at the hospital (not having received my medical aid membership number) I was asked to just get it from Discovery. Upon contacting Discovery I was told that my membership isn't active yet and that they can't help me, and I need to phone in again in the morning as they don't have access to new member details.<br /><br />This was after 6pm. My daughter was admitted to hospital and I had to pay R15000 upfront from my own pocket. Hoping this was just a glitch and that I would be able to claim back from Discovery.</p> <p> </p> <p>The following morning after multiple back and forths I was given a form stating that I now had a 3 month waiting period which would mean nothing would be covered. This itself became a back and forth fight with Discovery as they kept wanting to apply the waiting period, but with the help of MedWay they finally accepted that they were wrong and because I came from a closed-scheme they were LEGALLY not allowed to apply a waiting period to my membership.</p> <p> </p> <p>At this point I finally thought that I could start processing this claim. It is now exactly one month later and I'm still waiting for Discovery to come to the party, yet I just constantly get excuses. MedWay again tried to help but kept getting told that the claim submitted is unclear/bad quality. When I submitted the same claim I was told the following: <br /><br /><strong>Reason for short- or non-payment: 268</strong><br /><strong>We did not pre-authorise this procedure. To review payment of the claim, we have requested the clinical indications for the procedure from your provider.</strong><br /><br /></p> <p>This to me is unacceptable. I was supposed to be covered from the 1st of June, Discovery dragged their heals and now don't want to pay because it wasn't pre-authorised. It would have been authorised if they didn't want to dodge giving me service that I pay for.</p> <p> </p> <p><strong>So these are questions I would like to pose to Discovery:</strong></p> <p>a) Why did it have to be a fight to get my waiting period removed when the Medical Aid Schemes act clearly states the legalities around this?</p> <p>b) How was I supposed to pre-authorise a claim when I couldn't be helped by your call centre staff because apparently my membership wasn't active, 5 days after it was supposed to be?</p> <p>c) What are they planning on doing about this?</p> <p> </p> <p>At this point, I will not refer a single person to Discovery. I used to be with them for just over 4 years, moved to a closed scheme for 2 years and now I'm back with Discovery and just getting punished for something I'm paying for. I worry about what their excuse will be the next time something happens to either my wife, child or myself and we need hospitalisation. At this I'm unsure why I'm paying, as I'm footing all my medical bills from my own pocket anyway.</p>