1 reviews | Active since Mar 2009
Discovery Health focused on red tape
Yesterday I received a bill from my dentist which was strange I never received a bill from them before, i was always covered. So today I called to query why I received a bill from the dentist who advised the medical aid did not cover all the treatments provided. This was strange so I called discoverys contact centre who provided me with the details of the dentistry department, who assisted me in dissecting the codes and treatments not covered. I was shocked at the pathetic reasons I received for some of my treatments not being covered. I.e we all pay for sterilization of instrumentation as a result of extraction or draining of a abscess, SERIOUSLY - sterilization is essential for any treatment not just those. I am really sick and tired of all the red tape and pathetic excuses I get from discovery for claims not being covered. I feel you guys are more concerned with red tape rather than a clients well being and health. I am really annoyed at constantly having to validate and query codes. Surely there is a better way to service your clients without being consumed by red tape and rules which are not in the best interest of your clients
Thank you for your comment.
As discussed we confirmed that an external company administers the dental risk management through appropriate clinical review and advising when a dentist should authorise or motivate for procedures, depending on certain criteria. Selected, basic dentistry such as consultations, fillings and extractions are covered up to 100% of the Discovery Health Rate subject to a list of procedure codes only at a dentist in the KeyCare dentist network.
I confirmed that once the amended claims are received, we will process the claims for the dentist. The letter of motivation will be reviewed by the external company and a funding decision sent to the Scheme. If you require any additional information you may contact us directly.
Thank you for allowing me to assist with your query.
Kind regards
Jashvir
Thank you for your comment.
As discussed we confirmed that an external company administers the dental risk management through appropriate clinical review and advising when a dentist should authorise or motivate for procedures, depending on certain criteria. Selected, basic dentistry such as consultations, fillings and extractions are covered up to 100% of the Discovery Health Rate subject to a list of procedure codes only at a dentist in the KeyCare dentist network.
I confirmed that once the amended claims are received, we will process the claims for the dentist. The letter of motivation will be reviewed by the external company and a funding decision sent to the Scheme. If you require any additional information you may contact us directly.
Thank you for allowing me to assist with your query.
Kind regards
Jashvir