CG
Christo G

1 reviews | Active since Mar 2017

18 Sept 2019, 10:30

Discovery Gap fails to live up to expectations

Normally I have a high opinion of Discovery and now I have a big problem with Discovery Gap Cover, I have been a member for quite a number of years and have included my wife and kids on Gap Cover as well. My son went to a day hospital for dental work (2019.08.07) and needed to be under anesthesia (since he is only 3 years old), I got an approval (Ref ***) from Discovery four days before surgery.

With admittance to the hospital I had to pay R1100 and the staff also assured me this would be covered by my GAP Cover. The process was done and all went good. When I started to receive the bills, Discovery (true to their word) covered the costs of the in-hospital bill, but only up to the medical rates for the dentist & anesthetist.

Then came the battle that Discovery Gap Cover will not pay the differences, I have escalated this issue a few times already but no luck, each time I got told that it has been rejected because of the dentist is not a "specialist" (so they studied how many years to get a specialized degree???) and the anesthetist ( which we all agree is a "specialist") also not being covered because it falls under the dentist procedure and is being treated as 1 claim - even though I receive separate bills for each.

So after many calls and frustration I was promised a manager would call me, this also never happened. The end result so far is that I had to pay in over R5000 for costs which happened IN HOSPITAL in an APPROVED hospital COVERED in my policy. I pay a huge amount each month to cover me and my family and then I still have to pay extra when Gap Cover decide they not gonna pay.... totally ridiculous and unfair, this experience leaves a bad taste in my mouth - NOT what I expected from Discovery!!!

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Replies (3)
Discovery Health
Discovery Health's reply18 Sept 2019, 11:17
Official
Dear Christo

Your concerns are important to us. We will contact you soon to answer your comments.

Kind regards
Discovery Health Servicing Team 


CG
Christo G's update20 Sept 2019, 17:47
Reviewer Update
So today i received the call, and the ridiculous conclusion is that because it was in a DAY HOSPITAL AND NOT A HOSPITAL my claim will not be paid. even though the email i received states: " specific out-of- hospital costs related to an approved hospital admission " and i did receive the authorization so i will stay with ridiculous conclusion!!!

To everyone using them please ensure that you read all the fine fine print and not get left with the bill as what happened to me!!

I leave my 1 Star Rating for the bad experience and the R5000 that i have to pay myself because of Discovery Gap Cover, and i will be looking at alternative options in the meantime.

Discovery Health
Discovery Health's reply23 Sept 2019, 09:57
Official
Dear Christo

We have been in touch with you to answer your comments.

Regards
 Discovery Health Servicing Team