DISCOVERY HAS NO CLAIM PROCESS ....UNHAPPY CUSTOMER

WAITING FOR THEM TO RESEND UPDATED INVOICE AGAIN.

I DONT SEE HOW YOUR REASON CODES CHANGE EVERYTIME.

DISCOVERY IS CLEARLY LOOKING FOR A WAY NOT TO PAY

ON THE 22 JANUARY THIS WAS YOUR REJECTIONDear Mr Abdool Karim Thank you for contacting us.

Claim query

I trust that you are safe and well.

I have tried to phone you, but I was unable to reach you.

Please accept my apologies for trying to contact you at an inconvenient time.

I was hoping to discuss the below claim with you as we need to confirm who was the requesting or referring provider for the MRI:

Date of Service

Name of provider

Amount Claimed

Amount Paid

Paid To

Date of Payment

2020/12/17

Scholtz, De Jager and Associates

R6965.20

No payment

N/A

N/A

Funding for the claim is currently rejecting due to the fact that the claim does not indicate who the requesting or referring doctor was.

On the KeyCare Plus Plan only a specialist can refer you for a MRI or a CT scan.

If you were referred by a specialist for the scan, then we would require an amended accounted with the referring specialist’s practice number.

Yourself or the provider can send the statement or receipt to *** or fax to ***and allow a turnaround time of 2-3 working days.

If you were referred by a general practitioner for the scan then you may submit the reports and documents on our website www.discovery.co.za using the “Get Help” option and allow a turnaround time of 2-3 working days.

If you have any more questions, please visit www.discovery.co.za to Get Help or download the Discovery app to view your benefits and manage your health plan.

We will add all your recent interactions to your interaction timeline within 24 hours. You can track and update your queries there.

Regards Lee Adams Discovery Health (Pty) Ltd On behalf of Discovery Health Medical Scheme

THEN YOUR NEXT REJECTION CHANGED AGAIN DATE :27 JANUARY 2021

Reference number: *** Member number: ***

Dear Mr Abdool Karim

I trust that you are well and keeping safe.

Documents received

Thank you for contacting us. I have received your query and have extensively reviewed the documentation that you have sent to us.

I have found that you have provided us with a medical report, a referral as well as an invoice from your healthcare providers.

Thank you the documentation. We are unfortunately not able to use any of the documentation in order to reprocess your claim as confirmed by Lee. In order for us to reprocess your claim, we require a clear tax invoice from Scholtz, De Jager and Associates including your referring specialist's practice number on the invoice.

The updated invoice must be sent to *** so that we can reprocess the claim accordingly. This usually takes between three and five days after receipt of the updated invoice. Kindly note that i have concluded feedback to this communication for ease of reference for you.

I would like to apologise for the delayed resolution to your query and hope the above assists in resolving your claim query.

THEN WE SENT THE DOCUMENTS REQUESTED ON THE 29TH AND NO FEEDBACK.

WE THEN CALLED ON THE 10TH FEBRUARY TO CHECK UP AS WE HAD NO FEEDBACK.

SHONTONAY THEN REQUESTED ALL THE INFORMATION AGAIN, WE SENT IT.

TODAY THE 17 FEBRUARY 2021 AGAIN REJECTED BUT NOW YOU'LL HAVE A DIFFERENT REASON

CLEARLY YOU ALL WORKING ON DIFFERENT PAGES AS WE GETTING DIFFERENT REJECTION CODES THIS IS A BIG JOKE AND ILL FORWARD ALL MY INFO ON ALL PLATFORMS CAUSE THIS IS ABSOLUTELY RIDICULOUS THAT DISCOVERY IS LOOKING FOR DIFFERENT REASONS TO REJECT IT AND CHANGING THE REASONS AND INFORMATION 3 DIFFERENT TIMES!!!!!!

I WILL EXPOSE DISCOVERY ON BEING DISHONEST , LEE WONT PROCESS CAUSE THE SPECIALIST DETAILS WERE NOT ON IT THEN WE SENT IT THEN NO FEEDBACK FOR A WEEK, UNTIL I HAD TO CALL THEN AGAIN HAD TO RESEND NOW YOULL HAVE A NEW REJECTION

TODAYS REJECTION AS TO WHY THEY NOT PAYING 17 FEBRUARY 2021 IS THAT I NEEDED AUTHORISATION BEFORE I WENT FOR AN EMERGENCY MRI. AFTER THEY ASKED ME FOR THE LAST MONTH FOR ALL THIS INFORMATION THEY NEEDED TO REJECT AGAIN WITH A TOTATALLY NEW REJECTION AND REASON THEY WONT PAY. SO TODAY THEY REQUESTING ME TO GO BACK TO THE SPECIALIST TO GET HIM TO FILL OUT A FORM AFTER A MONTH OF ASKING FOR OTHER DOCUMENTATION!!!!

PATHETIC SERVICE AND SOUNDS LIKE THEY JUST LOOKING FOR REASONS NOT TO PAY, WHY WOULD A DIFFERENT CONSULTANT HAVE A DIFFERENT REASON. CLEARLY DISCOVERY IS RUNNING SOME **** OR HAS NO PROTOCOL THEY FOLLOW WITH REGARDING CLAIMS WHY DIFFERENT CLAIM PROCESSES 3 TIMES.... DISHONEST COMPANY

UNHAPPY FRUSTRATED CLIENT