Discovery Claims Process

I’ve had an ongoing query with Discovery Health since March without resolution. The product itself is already so complex as member, it makes the experience even more painful when the people who are supposed to help you don’t understand it either.

I sent an email on the 19th March initially, seeking help with my wife’s claims which have now depleted our MSA for year which should be paid from Oncology, due to what I assume is a failure in the claim process between service providers and Discovery. I was then sent verification emails and the claims transaction history which did not answer the questions I had. A month later (May 3rd) after follow up emails, I received an email which confirmed my aforementioned assumption, claims were being paid using incorrect codes. I presume there some that were meant to paid by Oncology and some from the Hospital benefit. So was given a breakdown of all the incorrect codes that were used as if I would know what it all meant, but still without resolution. I responded to the email, yet almost another month has passed without a response, yet the issue with my wife’s claims still persists.

My wife has been on Oncology almost 3years and she is now in remission, but I have never experienced the amount of stress with Discovery throughout. The process has been seamless till now.

Based on your findings, Discovery should have not paid the claims because of incorrect data provided. As a member I have no sight of the backend process, I have no idea what an ICD10 C20 is and now you're subliminally telling me that I have to get the claims reversed and processed with the correct codes? Nonsense, why were the claims processed incorrectly in the first place.

Can you have the claims reversed and reprocessed correctly as they should have.

Please do not call me, I prefer email. If you prefer to call, you can contact my son, Saziso Ndimande who is a Discovery Vitality employee.