DD
Debby D

1 reviews | Active since Jan 2014

07 Oct 2019, 12:43

Discovery Health Hospital Claim Nightmare

My daughter was admitted to Hospital on 16 July this year as an emergency. I followed the Pre-Approval process and was given the Authorization number. A number of the bills were settled by Discovery Health without question (xrays, bloods, ENT). However I am left with the 2 largest bills remaining as outstanding - The Admitting & Treating Doctor's Bill and the Full Hospital Bill. I was told the Admitting Dr needed to fill in a PMA (Personal Medical Assessment) Form. I made multiple follow-ups (yes I have a truck load of Reference Numbers) and the Dr never received the form from Discovery. Eventually I asked Discovery to send the form to me to try and resolve. Guess what it took a further 4 phonecalls (with references) before I eventually received the form and forwarded it on to the Dr - so I an well believe the Dr never received the form! The Dr duly filled in and submitted the PMA it on 27/09 - Discovery acknowledges this as they have paid the claim to the Dr for filling in this form!!! There is still no resolution on this even after me having phoned in twice to follow-up and escalate, and having laid a complaint. I was told it takes 3-5 days to process but it is still in "Finalization" state even after my escalation. When you have paid for your child to be on Discovery for close on 18 years and this is their first ever hospital admission - I shudder to think the amount I have paid Discovery Health over the years only to receive this dispicable service. Yes my daughter has an exclusion for a Pre-Exisiting Psychological condition, but how this could possibly be at all relevant when the child collapsed unable to breathe when participating at a Sports Day, was transported to hospital by ambulance as a result, and in hospital she was diagnosed with a viral infection, only Discovery can tell. I am so angry and disillusioned with this medical aid and their shoddy service, and the fact that they just never follow up on anything.

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Replies (4)
Discovery Health
Discovery Health's reply07 Oct 2019, 13:51
Official
Dear Debby

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 reply09 Oct 2019, 13:14
Official
Dear Debby

We have been in touch with you to answer your comments.

Regards 
Discovery Health Servicing Team 


DD
Debby D's update13 Dec 2019, 07:45
Reviewer Update
A follow up on this incident. Discovery Health was very quick to phone me and email me after this posting but they did nothing to actually resolve my issue. They sent an email to the supplier and waited for a response. When I tried to follow up with them they told me just that, that they had sent an email and were waiting for a response - no other attempt to follow up and resolve the issue.
I then tried to contact the Scheme Principal I received similar treatment.
AS this is not being taken seriously by Discovery - clearly small clients are not worth the effort - I took this to the Council for Medical Schemes. Discovery did not bother to respond to them within the required 30 days either, and it is now with a Senior Legal Adjudicator for Final Determination.
Hopefully I will get some form of conclusion from the Council for Medical Schemes as I am never going to get one from Discovery.
I am completely disillusioned with them and their service, and I have given them the benefit of the doubt at every opportunity.
DD
Debby D's update06 Jul 2020, 14:38
Reviewer Update
A further follow up on this incident. The Medical Aid Adjudicator process with the Council of Medical Schemes was a long one, but Discovery did finally agree that they incorrectly app**** the waiting period (almost a year later).
The problem didn't end there, I then had to go back to Olivedale hospital and ask them to resubmit the invoice from 2019 without the incorrect ICD code which had caused the incorrect waiting period to be app****.... Because until this had been done "Discovery systems" would not allow them to pay out the amount owing. I then had to convince Olivedale (with loads of documented proof) that I was not making this up, and they did have to resubmit the claim minus this one ICD code.
When I finally did that, I received a payout - from Discovery for the amount owing. I then paid this on to Olivedale Hospital, and assumed that all was settled.
But wait there is more...
Today I get an email from Discovery to say I OWE them money! And yes it is related to this account. So turns out in their wisdom, Discovery paid BOTH Olivedale and Myself. So now this saga continues. Discovery is after my blood to make a settlement arrangement for the outstanding amount. And I am now explaining (and having to prove) to Olivedale that they were paid TWICE, and they need to re-imburse me the money.
How many times can Discovery mess up one account?
The amount of time, phonecalls and emails this has taken to resolve is crazy, and here we go another round...