MI
Michael I

1 reviews | Active since Mar 2009

24 Jan 2020, 16:17

Discovery Health are totally unreasonable with PMB.

Beware of your rights with PMB: I was admitted as an emergency with a broken toe that required a plastic surgeon. This required work in the operating theatre, when wires were inserted into the toe. After 6 weeks, operating theatre again to remove wires. Imagine my surprise when the surgeon and anesthetists were not paid in full, as I had, "voluntarily selected these service providers" not on the Discovery panel. After 20 to thirty phone calls and emails, they eventually relented on the first operation surgeon, but apparently I should have hand-picked my anesthesiologist...he is still not paid. Hint: through the mist of pain, hang in long enough to pick a Discovery Panel person before you pass out, or you will be refused full PMB. I am now taking this up with the Council for Medical Aids, the Ombudsman and probably a civil court case. It does not sound ethical that a doctor works on you, and is then pushed off the case so Adrian Gore can upgrade his Porsche.

0
Replies (2)
Discovery Health
Discovery Health's reply27 Jan 2020, 10:23
Official
Dear  Michael I
 
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 
MI
Michael I's update30 Jul 2020, 09:54
Reviewer Update
After countless email correspondence, each one with a different person, it is still unclear what happened. Even my Gap insurance policy people got confused, and also challenged Discovery. It seems Discovery did pay extra amounts (which they should have done in the beginning), but these are just labelled, "adjustments". I believe they rely on discounting their cover by rejecting, and then wearing you down with a carefully constructed set of replies, each by a different person each time. Do ***not*** rely on their authorisation for a service. If you are suffering and need urgent care, be prepared for a marathon. Note that the plain vanilla reply to my complaint above never resulted in anything that I could discern.