ZN
Zayn N

1 reviews | Active since Jun 2019

19 Feb 2021, 13:27

Discovery Health cannot process simple medical claims

Hello, I saw an ENT specialist for a consultation on 10 February 2021. I paid the specialist on the day and received a invoice with all the salient details to claim such amount from Discovery Health. I submitted such invoice document on the Discovery App for payment on 10 February 2021 - I have sufficient savings coverage for this claim on my Coastal Saver plan. The claim was rejected via a code 192. I called the Discovery Health call center on 12 February 2021 and an agent informed me that the invoice was not clear. I submitted the claim again via email on 12 February 2021. I received feedback from a Discovery consultant (Emile Stadler) that the claim was unclear, again via email on 16 February 2021. He provided a list of information that should be present on the claim / invoice form. All of such information requested is present on the claim form - I responded to him by attaching my bank details and the invoice claim again along with responding point by point to his information request. I also copied in the accounts department of the ENT's practice on the mail - they sent through a copy of the claim to Discovery and myself as well. On 17 February 2021, I received an email from another Discovery consultant (Zakkiyah Ganesh) stating the claim / invoice form is unclear and provided me with a list of information that needs to be present on the claim / invoice form. I responded to Zakkiyah by email on 17 February 2021 - screenshotting the claim form to indicate that the information required to process the claim is present on the form - I did this point by point. I also requested a Discovery manager to call me regarding this claim in my response to Zakkiyah. To date I have heard nothing from Discovery Health. Its clear that Discovery Consultants lack the common sense to process a claim form and can only send out generic emails instead of applying their minds. Or is this just an excuse by Discovery to stall paying legitimate medical claims?

0
Replies (3)
Discovery Health
Discovery Health's reply22 Feb 2021, 06:42
Official
Dear Zayn N

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

Discovery Health
Discovery Health's reply23 Feb 2021, 17:15
Official
Dear Zayn N

We’ sent feedback to you on the concern received. 

Regards 
Discovery Health Servicing Team
ZN
Zayn N's update23 Feb 2021, 17:53
Reviewer Update
Good day,

I have received an email from Gabriel Joseph at Discovery Health (I missed his call as I was in a work meeting). Yet again the response from him is that the claim invoice previously submitted is unclear, but Gabriel did not stipulate what specific information is unclear or missing from the claim invoice. I have responded to Gabriel by sending through two clear copies of the claim invoice as well as confirmation of my bank details. Yet again, I have screen shot information directly from the claim invoice to align with and answer the information requested by Discovery Health from the claim form; in the body of the email to Gabriel from myself. I also copied in the ENT's account department and my broker in the email. The claim invoice is a standard A4 page in PDF format - all information is easily readable off of it. It is not necessary to do so but even if it were, it is not difficult to zoom in on the claim invoice using Adobe Acrobat or similar PDF software. Discovery Health has no excuse not to process this claim.