Disappointment and frustration with claim

<p>During November 2016 my wife made an appointment for a mammogram and ultrasound for 10-01-2017.</p> <p>Within a few days she received a call from the receptionist that the Practise had been informed by Discovery Health that it would only be paying for such procedure every 2nd year in stead of every year. This despite the fact that Discovery had increased our premium with around 14,7% (double the inflation rate). And at the same time taking away benefits despite the premium increase.</p> <p>This was implimented unilaterally by Discovery, and policy holders didn't have any option but to comply. What about members who don't receive income increases at the same rate, and pensioners ? During 2016 the increase was close on 10 %. A compound increase of about 25% over 2 years. Then towards the end of 2016 we read in the papers about the exhorbitant remuneration packageses the executives receive. </p> <p>Due to previous diagnoses and surgery my wife was instructed by her Doctor to undergo mammogram and ultrasound every year. </p> <p>On 30-11-2016 my wife wrote a review on hellopeter regarding this situation. Some days later a representative from Discovery called her and gave lengthy and tedious explanations for Discovery's decisions and actions. He assured her that "due to the nature of her circumstances" and with her medical history/prognosis her procedure would be covered every year, and also since it was a condition that existed before the changes.</p> <p>On 10-01-2017 my wife went for the appointment and was afterwards required to pay an amount of R1,396-80 as there was no approval from Discovery. On the same day she wrote an email to Discovery explaining the situation, mentioning the call she received from Discovery after the review on hellopeter and assuring her that her procedure would be covered every year, and attaching the account and the report from her Doctor clarifying her condition and previous surgery.</p> <p>On 30-01-2017 she received an email from Discovery saying, "Please note we have processed your claim dated 12-01-2017 for Van Wageningen and Partners Incorporated for R1,396-80. We have paid this claim in full to the provider from your Screening and Prevention Benefit at 100% of the Discovery Health Rate on 18-01-2017. We do apologise for the delay in responding to your query." </p> <p>On 13-02-2017 I wrote an email to Discovery asking who THE PROVIDER was that the full amount was paid to, as my wife needed to be refunded since she paid the account. </p> <p>Then on 15-02-2017 I received a reply from Discovery saying, "We have processed the following claim dated 10-01-2017 for R1,396-80 for Van Wageningen and Partners Incorporated. We have not paid this claim as per rejection code 322 you have reached the limit for Screening and Prevention Benefit. Please be advised this is member's own liability to settle."</p> <p>While this was the 1st mammogram and ultrasound for 2017, and the previous one in January 2016.</p> <p>What an about turn ! Shocking for any "reputable" company, to say the least. </p> <p>We have copies of all email correspondence with Discovery.</p> <p> </p>