RB
Rosalyn B

1 reviews | Active since Dec 2010

13 Jul 2022, 14:52

Discovery health irritating inefficiency

Sick& tired of Discovery (DH) & their constant excuses as to why they cannot apply what they claim they will for plan selected! Frustrated & irritated with call centre for various medical queries, where each consultant that's meant to assist gives a different version/reason for 1.rejection, lack of fulfillment of DH's obligations etc; 2. of the rules and why benefit not app****; 3. of requirements to obtain benefits as per medical aid category "comprehensive" guide; 4. the process to be followed to obtain benefits, authorisations, claim repayments etc etc to name a few!! To be as brief as possible. I'm on DH classic comprehensive medical aid category (2nd highest). I pay a high premium monthly to obtain better benefits. I went in for colonoscopy on 5th July 2022 to Morningside clinic. I'm currently out of MSA, have no self payment gap (SPG) to close & am in my so called ABOVE THRESHOLD BENEFIT (ATB). I phoned on 4 July (not going to give time etc as DH can ask)& got authorisation but was given a list of T&Cs, which I could not grasp as quickly as spoken & actually should have checked to plan's info of benefits, before I agreed ( but not given option). However I was told as expected that no co payment would need to be paid as ATB. Told I'd receive email to verify what had been discussed on call but never received it! Next day, 5 July, got early SMS saying co payment needs to be paid. Phoned DH authorisations (DHA) & was given another version of benefits & how to be allocated (if I remember some in hospital & some other benefit but no co payment). Also told report needs to be sent and if related to related PMBs (Huh? None related) may not be refunded. Consultant told me problem was on clinic's side. Arrived at clinic to admit myself &am surprised to be called over to another counter & told to pay co payment of 6900. Tried to reason with admission staff but he called credit control employee who told me that in system, DH noted I need to pay co payment - nothing clinic could do about it. I phoned DH 3rd time at clinic counter & was told co payment necessary as procedure not in doctor's actual rooms but under sedation in day ward/ clinic. Credit controller spoke to DH consultant but was confused too - said doctor's don't do it in their rooms. Anyway no one knew anything & 'blamed' one another. As I had spent few hours on phone/clinic's counter & was now late for admission, I just paid it on credit card (cc). My doctor would like her payment now, which is expected, but I have to fight about R6900 on CC too with DH. Really angry - DH always seems to have reasons/ staff that doesn't know enough detail/ not on same page, misunderstand & you as member now subjected to fixing up mess at your inconvenience & to deal with DH's inefficient system.

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Replies (1)
Discovery Health
Discovery Health's reply14 Jul 2022, 07:17
Official
Dear Rosalyn B

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