fF
funeralsociety F

1 reviews | Active since May 2016

10 May 2016, 20:02

Discovery authorizes my hospital visit and does not pay

<p><span style="color: #555555; background-color: #ffffff;">On 25th April 2016 I went to a Dr (ENT) and he said I should be admitted to which I took the do***ents and went to Lenmed reception and presented myself with the docs to which the lady Jean Dawood ***isted me. She told me the auth is pending due to it been a new medical aid and asked me do i want to be admited while it gets authorized to which i said no as in case for some reason it declines and im in problems. I went home and few hours later received an sms and then a call from Jean to say its authorized and to come in to be admitted. I proceeded and got admitted. The doctors did whatever tests and then i got discharged by 29th April 2016. Now I see that no claims are been paid as it says i did not get authorization, I called discovery and they told me they need pma form to which my Dr sent 3 times. now today they say they need gp letter referring to specialist to which we also provided. This is so annoying and I am not going to leave discovery until justice is done, I mean why play games with me and my health? On lenmed system it shows authorized with an authorization number and on your website it shows the same, so why bull**** me around now? Please sort this matter out as a matter of urgency please.</span></p>

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Replies (2)
Discovery Health
Discovery Health's reply13 May 2016, 11:29
Official
Thank you for your comment. When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there were any pre-existing conditions of which we were not aware. We have confirmed that you were contacted telephonically by the Standards Team yesterday and was advised on the protocol that we app**** when making this decision. Regards Discovery Health Servicing
Discovery Health
Discovery Health's reply13 May 2016, 13:12
Official
Dear Preyalan We have reviewed your concerns and found that they have been addressed by the relevant department. Due to the sensitivity of the information please contact them directly for further queries. Regards Discovery Health Servicing