JN
Johan N

1 reviews | Active since Mar 2022

21 Feb 2025, 13:03

Discovery Health Medical Aid program fails paying member.

Discovery Health is not providing Plan Benefits as paid for as a member under Health Pathway Program. My monthly Discovery Health membership debit order goes through every month, on time and the money is available to Discovery Health immediately. Why should I as a member then not receive my plan benefits as outlined in my membership plan and agreement?

I am not sure if it is an administrative challenge with the launch of Health Pathways for Discovery as the new program rolls out. I have encountered problems and even though I logged it there seems to be a general disfunction with the program.

Please may I just ask why the assessments are given, I then follow the instructions, use Discovery Network Medical providers and doctors as per the instructions, and then the cost of the consultations is not paid, the visits not credited and I end up with out of pocket expenses that I would not have had in the first place?

As a loyal member to Discovery Medical Aid, I feel that the benefits and services are not as it is given in the Health Plan outlines. I do not feel that I have been taken advantage of and it misrepresents the service, benefits and outlined care that I pay for on-time as a member.

I had to go back to the Discovery Network Listed Doctors feeling embarrassed and having to ask if they could give me a letter of proof that I have done the Diabetes Screening. I have done the Foot Screening, I have been to the Network Opthalmalogist screening, but now I need proof to get my consultation fees back from Discovery and for having followed their instructions. Why? Either the Discovery Network Service list is outdated and incorrect or the Health Pathway Program is not managed and operational.

And then the doctors say " It can only be Discovery Medical Aid again!" I as a member then have to say that I followed the instructions, attended Network Listed doctors and I just want to claim back and have my visit and assessment recorded on Health Pathways.

As a member I can not afford my monthly premium and in addition pay for Health Path Assessments out of pocket and end up with no benefit.

It is not fair and ethical. I now have to carry negative credit card payments having followed the Discovery Medical Aid Health Pathways "member health benefits" program.

Remove the program or make corrections on this please. I cant afford it anymore as it is disfunctional with a negative financial impact on me as a member. If I pay my membership, then Discovery yas a responsibility to provide me the benefits I paid for as a member?

0
Replies (9)
JN
Johan N's update23 Feb 2025, 09:21
Reviewer Update
Discovery Fails Paying Claims and recording Health Pathway Assessments & Benefits completed.

Health Pay / Health Assessments, Health Pay / Vitality not recorded.


Discovery Health proved me right and confirmed that they have problems that impact members, and this happened on 22 February 2025.

On Saturday 22 February 2025 at 10:40 I receive a notification from Discovery Health to complete my Health Pathway Assessment.

It proves my previous complaints that record keeping for Health Pathways, Vitality, Health Checks and Claims are not being recorded.

I have submitted all my Health Pathway Visits electronically since 7 February. It is not recorded and this proves that the recordings are not happening.

Health Pathways Assessments completed:
- Diabetes : 7 February : Submitted but bot recorded.
- Foot Assessment : 7 February : Submitted but not recorded.
- Retina Screening : 14 February : Submitted but not recorded.
- Dental Check-up : 20 February : Submitted but not recorded.

I attach files as proof that I have communicated, submitted and completed Health Pathway Assessments and that it is not actively captured by Discovery.

It is clear that I am just one of many members experiencing the same. Claims rejection rate is high, Claim frustration from Medical Practitioners, Claims and Health Program Data and benefits not recorded on members profiles.

Member rating on Discovery Health

Discovery Health
Rating : 1.51
Number of Discovery Member Revies: 18 532

Performance (Rolling 12 months):
Trustindex Rating : 2.7
Ranked In Medical Aid service : 15

111 Reviews : 0 /5 Rating
212 Reviews : 3/5 Rating given
3,260 Reviews : 2/5 Rating given
13,601 : 1/5 Rating given

* Live HelloPeter rating index : 2025
Discovery Health
Discovery Health's reply24 Feb 2025, 06:47
Official
Dear Johan N

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 reply28 Feb 2025, 17:04
Official
Dear Johan N

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

Regards 
Discovery Health Servicing Team
JN
Johan N's update01 Mar 2025, 07:54
Reviewer Update
I have been promised that action woll be taken . I received a call on 28 February from an agent. I was promised that a ticket has now been openend to correct and update my Health Pathways.

As soon as that is corrected, I will post the final outcome and service experience on Discovery Health.
JN
Johan N's update05 Mar 2025, 14:56
Reviewer Update
Today at14:55 a Discovery Agent opened another ticket to update completed Health Pathway Assessment for me.
JN
Johan N's update05 Mar 2025, 15:01
Reviewer Update
Today I logged a complaint at the Health Medical Council for payment of my Retina Scan as a Diabetic patient. I have also submitted another follow up email to the Principal Officer at Discovery, in copy to mydisputes and the Health Council. My practitioner will support me in my quest to get Discovery Medical Aid to accept responsibility and ownership by submitting multiple claims until Discovery Accepts their recognised ICD Code that they do not declare to members to allow processing of a legitimate claim with legal supporting documentation.
Discovery Health
Discovery Health's reply11 Apr 2025, 11:36
Official
Dear Johan N 

We are busy investigating your query and will contact you soon.

Regards 
Discovery Health Servicing Team
JN
Johan N's update11 Apr 2025, 13:50
Reviewer Update
Thank you. My problems and concerns were addressed and rectified. Johan
Discovery Health
Discovery Health's reply11 Apr 2025, 16:52
Official
Dear Johan N 

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

Regards 
Discovery Health Servicing Team