NM
Nokuthula M

1 reviews | Active since Mar 2021

02 Mar 2021, 13:36

Discovery Health is ****inng clients

I've been with discovery health for more than 5 years, I don't use most of my benefits. Last year I fell pregnant, I activated my pregnancy program as per discovery requement. On the 7th January I consulted a gynecologist, I was already 20 weeks. He requested some blood tests one of them is NIPT which he explained that it's needed since I'm over 35 years the is a high risk of a baby to have down syndrome. My pregnancy is a high risk. I went to Amphath lab to do the blood tests. After 2 weeks I recieved an invoice from Amphath lab that the medical aid didn't pay the full amount for NIPT. I called discovery, the consultant told me that the doctor was suppose to send a report explaining why I had to do NIPT, then they were going to pay it under my maternity benefits. They took all my day to day savings and to pay NIPT and the was still an outstanding balance. I'm a 27 weeks pregnant woman who doesn't have day to day funds because discovery doesn't want to pay NIPT under maternity benefits. I made a follow up, I was told I must submit the NIPT results so that they can see if it's suppose to be paid under maternity benefits or what. I sent the doctor's motivation letter and the NIPT result. I was told it is rejected because I don't meet the clinical criteria for NIPT. I requested them to explain the clinical entry criteria they said I don't meet. According to my benefits I am entitled to one NIPT test to be paid under maternity benefits. No one has explained the creteria. Discovery health is a service provider I pay every month, they suppose to pay what they are paid for.But now they are sending from pillar to post wanting every reason not to rander the service paid for. They are suppose to state their creteria on their benefits not come with excuses when they are suppose to pay. That is an unatheical practice. Every cover that has fine prints they state those fine prints they don't come as a surprise when it's time to render the service

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Replies (2)
Discovery Health
Discovery Health's reply03 Mar 2021, 06:53
Official
Dear Nokuthula M
 
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 reply04 Mar 2021, 09:55
Official
Dear Nokuthula M
 
We have been in touch with you to answer your comments.
 
Regards 
Discovery Health Servicing Team