1 reviews | Active since Apr 2015
Discovery Health Being dishonest?
Earlier this year I was scheduled to undergo an Oesophageal Manometry study. My surgeon's rooms provided me with the ICD 10 and procedure codes so that I could contact Discovery Health and get Authorization for the procedure. On the 18 th of January 2023 I contacted discovery health to get the procedure authorized. According to the customer service agent that assisted me I was told I would not need authorization since the procedure is performed in the surgeon’s rooms and that the procedure would come out of my MSA. I would only need the following Reference number:*** . Reference numbers for the above-mentioned calls are: ***, ***, ***, *** and *** The procedure did not go ahead on the scheduled date since there was technical issues with the Manometry machinery. I contacted discovery on the 1 st of February and explained that there had been technical issues and that the procedure had been moved to the next day. I was assured the reference number I was originally given for the procedure was still valid. Call reference Number: *** The 20 th of February I had surgery. At my follow up appointment, I enquired about my account and was informed there was an amount in arrears. The amount in arrears was due to unpaid fees for my Manometry study. This should not have happened since my medical savings account had sufficient funds. Only R2,447.40 of the R4877.23 was paid. The rest of the claim was rejected (1582 x1 Oesophageal motility (4 or 6 channel + pneumogram)). The rooms followed up with the medical aid on several occasions and were given assorted reasons for the claim being rejected. One reason was that the Manometry scan needed prior authorization and only children under 12 did not. Another was that the medical aid simply did not pay for the procedure code 1582. This is very confusing since I had several conversations with Discovery regarding the authorization of the procedure and was told it was not needed. Discovery Complaint I was also not informed of any co-payments for the ICD 10 codes. Discovery is liable for the outstanding amounts due to their own fault at communicating the correct information to myself and the surgeon’s rooms. I would also like to request that an investigation be launched into the recording of the phone calls I made to Discovery prior to the procedure. I also request that a copy of these recordings be forwarded to me for my own records. I will in not bear any responsibility for the outstanding financial obligations. Discovery Health is at fault and should bear all responsibility for costs involved in settling the account. I expect this matter to be resolved in a timely manner and that I be kept informed at all stages of the investigation.
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
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
We have been in touch with you to answer your comments.
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Discovery Health Servicing Team
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
