RJ
Roger J

1 reviews | Active since Feb 2018

12 Dec 2020, 06:26

Discovery health chronic meds pricing/tariff inefficiency

Ordered my chronic meds from Dischem recently. They informed that this time there is a co-payment on one of them. Queried Discovery who advised: >>> Quote: Reason code 476: We paid the amount on this line at the agreed dispensing fee for this network pharmacy. I have found that the agreed rate has changed in error. I have sent the claim for reprocessing, please allow 2 to 3 working days. Unquote <<< I see in downloaded claims history that some form of re-processing took place on 10 Dec but no discernable outcome evidencing rectification. Am waiting for further developments on their side But, the obvious questions are: 1. When was the "agreed rate" changed in their system? 2. How many members were charged the co-payment as a result? (The med in question is for cholestorol management so probably high on the list of chronic med claims) 3. How many affected members queried it? (I'm guessing not many - it's "only" 5.26 - akin to the R99 ********** debit order ****s) 4. Will Discovery adjust/refund across the board or will they only do so for those members who took issue?, and; 5. Will Discovery make a nice bundle out of charged and un-refunded 5.26s? 6. Will they address all affected members to advise of the error, the refund/adjustment and present an apology for their inefficiency and the inconvenience caused? And, to end, a year after protracted interactions with Discovery over the often uselessness of their claims history downloads - specifically in respect of not presenting accurate MSA balance info to members - the situation remains unchanged. I still don't see an accurate presentation of progressive changes to my MSA in the downloaded histories. This has been the case for years and it beats me why they can't and haven't fixed it. Perhaps it suits them not to?

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Replies (2)
Discovery Health
Discovery Health's reply14 Dec 2020, 07:10
Official
Dear Roger J
 
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 reply14 Dec 2020, 11:47
Official
Dear Roger J
 
Please check your email for feedback from us.
 
Regards 
Discovery Health Servicing Team