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Nolwazi N

1 reviews | Active since Apr 2012

18 May 2019, 09:56

Discovery claim unbelievable payback

I submitted 3 claims for R450 each, shockingly Discovery will pay back R111 for each antenatal visit to a midwife at Genesis. My midwife is Ntombi Mchunu and I believe she part of their network. I have booked to give birth at Genesis through the same midwife and Discovery has given me an authorization number. Kindly advise which midwife I should use who cost R100 for antenatal I can gladly switch. I thought by having a medical aid I won’t have to go through so much financial strain but it seems it’s the opposite considering that I am pregnant.

I am paying R1650 for booking a room at Genesis , R7500 for birth with the midwife as it is natural birth, R3625 for pedestrian. Which is all I have to pay upfront and I was told that I can submit invoices for claims to Discovery.

Now with you paying less than a quarter of the antenatal invoice amount what are the benefits of having a medical aid which I am paying R2000 every month. My medical aid is Essential Delta Saver. Even when I visit Dr Mokaya I am charged R400 cash because they say Discovery doesn’t pay them the complete money but I was told He is part of the network for Essential Delta Saver. I did blood test for my pregnancy and this amount was taken from my savings by Discovery not on maternity benefits and when I tried to understand why they said it’s because of the codes they used. I don’t know anything about codes, Discovery never inducted me the codes and their use. When I called their call Centre I was told they can’t share that information on codes with me I should call my Doctor to use the right codes, which one is the right codes?

I am really frustrated with the process. If Discovery has a midwife who charges R100 am glad to switch and in addition can you please advise on how much I will be getting back on claims I am paying R1650 for booking a room at Genesis, R7500 for birth with the midwife as it is natural birth, R3625 for pedestrian, please advise on the total amount that Discovery will pay me back so I will not be caught up with suprises because as is now am stressed considering the current pay back on my claim.

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Replies (2)
Discovery Health
Discovery Health's reply20 May 2019, 08:09
Official
 Dear mmmm7 

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 
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Nolwazi N's update31 May 2019, 16:42
Reviewer Update
One consultant called and said he will send me an email with a preassessment form and will further investigate the matter and get back to me but until today he has not called back. He never sent the email until I requested the preassessment form myself from Discovery call Centre, I filled it in and upon submission I was told Discovery will only pay R3000 for the R7500????. It really doesn’t make sense to me. I was hoping Discovery will resolve this but I feel it’s only about membership to them not providing the services.