DR
Donnya R
1 reviews | Active since Oct 2013
17 Mar 2016, 14:11
Discovery does not cover operation
My father was admitted to the sunning hill hospital in December with a authorization number and he had his op done. Then discovery health says the will not pay for the op after it had been done. My parents pay a fortune for the medical aid and when they need it they don't help them. The doctor now wants to hand the account over. We have emailed discovery and of course they do nothing about it. Please could someone get hold of me or is this asking to much. I suppose they have so many complaints they just shrug it off.
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Discovery Health's replyOfficial
22 Mar 2016, 15:22Hello Gutvol,
Thank you for your comment and taking the time to speak to me.
As discussed, an authorisation number was provided for your father's treatment. The treatment was covered by Discovery Health Medical Scheme in line with the authorisation and in accordance to your father's chosen plan type.
DHMS has multiple payment agreements in place to ensure that services rendered are covered in full, which the services providers have the choice of joining. There are however service providers who either choose to not participate or to opt out of these payment agreements. Unfortunately the providers who chooses not to participate in any of these payment agreements are not obliged to charge what your father's chosen plan type would cover.
To avoid co-payments, upon authorisation DHMS will inform you of any potential shortfalls and offer the use of the Discovery Website to ensure that you make an informed decision prior to the procedure taking place.
Whilst we understand that this is not the outcome you expected, I trust that this explanation provides clarity to the reason for the outstanding amount owed to the service provider.
Regards
Meryl
Thank you for your comment and taking the time to speak to me.
As discussed, an authorisation number was provided for your father's treatment. The treatment was covered by Discovery Health Medical Scheme in line with the authorisation and in accordance to your father's chosen plan type.
DHMS has multiple payment agreements in place to ensure that services rendered are covered in full, which the services providers have the choice of joining. There are however service providers who either choose to not participate or to opt out of these payment agreements. Unfortunately the providers who chooses not to participate in any of these payment agreements are not obliged to charge what your father's chosen plan type would cover.
To avoid co-payments, upon authorisation DHMS will inform you of any potential shortfalls and offer the use of the Discovery Website to ensure that you make an informed decision prior to the procedure taking place.
Whilst we understand that this is not the outcome you expected, I trust that this explanation provides clarity to the reason for the outstanding amount owed to the service provider.
Regards
Meryl
Discovery Health's reply22 Mar 2016, 15:22
Official
Hello Gutvol,
Thank you for your comment and taking the time to speak to me.
As discussed, an authorisation number was provided for your father's treatment. The treatment was covered by Discovery Health Medical Scheme in line with the authorisation and in accordance to your father's chosen plan type.
DHMS has multiple payment agreements in place to ensure that services rendered are covered in full, which the services providers have the choice of joining. There are however service providers who either choose to not participate or to opt out of these payment agreements. Unfortunately the providers who chooses not to participate in any of these payment agreements are not obliged to charge what your father's chosen plan type would cover.
To avoid co-payments, upon authorisation DHMS will inform you of any potential shortfalls and offer the use of the Discovery Website to ensure that you make an informed decision prior to the procedure taking place.
Whilst we understand that this is not the outcome you expected, I trust that this explanation provides clarity to the reason for the outstanding amount owed to the service provider.
Regards
Meryl
Thank you for your comment and taking the time to speak to me.
As discussed, an authorisation number was provided for your father's treatment. The treatment was covered by Discovery Health Medical Scheme in line with the authorisation and in accordance to your father's chosen plan type.
DHMS has multiple payment agreements in place to ensure that services rendered are covered in full, which the services providers have the choice of joining. There are however service providers who either choose to not participate or to opt out of these payment agreements. Unfortunately the providers who chooses not to participate in any of these payment agreements are not obliged to charge what your father's chosen plan type would cover.
To avoid co-payments, upon authorisation DHMS will inform you of any potential shortfalls and offer the use of the Discovery Website to ensure that you make an informed decision prior to the procedure taking place.
Whilst we understand that this is not the outcome you expected, I trust that this explanation provides clarity to the reason for the outstanding amount owed to the service provider.
Regards
Meryl