DISCOVERY HEALTH POOR SERVCE & FAILURE TO PROCESS CLAIMS TO CLIENTS

Hello!

Discovery Health Medical Aid is driving me from pillar to post when I request a claim for a specialized dental procedure (Silver bridge) that I paid for in cash to the doctor. When I first submitted the claim with the details of the actual procedures (including the part that was provided by the Lab) from the to the Doctor, Discovery requested the receipt as my proof of payment to the Doctor which I immediately submitted to them. Next they say they need my bank account that corresponds to the receipts and I also submitted that. Most of these piece by piece requirements are not done telephonically but mostly they are hidden in their email responses or in my profile within their medical aid website or discovery app. This causes more details in their processing because sometimes I don’t see responses as fast as I would if it was a phone call. Subsequently their 2 to 3 days processing time keeps on accumulating into many days.

They even ask for the Doctor’s practice number at a later stage which I find ridiculous because it was already there in front of them during my very first submission in the details that were provided by the doctor. Today, to my surprise, they say they paid the claim to the laboratory, why? I made the claim myself not the doctor & certainly not the Laboratory. All what the doctor provided me were the details of the of the procedure he did on me. The doctor did not issue any claim to them because I paid cash & I also attached the proof of payment as per their request.

I’m so disappointed with Discovery because it is so easy for them to take monthly premiums but so difficult for them to pay claims that are due to their clients.

Another issue, when I phone them I always get a new representative and I can’t find the original person who was assisting me because she is busy with something else. So, either I’m assisted by the new person starting from scratch or they will have to send an email to the original person who might reply me some other day, thereby extending more time for the claim processing.

I also came across a very rude representative called Nwabisa today who told me that my claim has been rejected because there is no referral doctor mentioned in my claim, without knowing all my claim details, which is precisely why I wanted to be assisted by the original representative in the first place. As I was phoning from my cell phone for a long time with Nwabisa, my call just cut off as she was looking for further details of my claim. She never bothered even to send a message to me of what she discovered about my claim even though she knew my details as she was looking at my profile during the call.

I started the claim last week on the 1st or 2nd of October 2020 but now this week is ending on 9th of October without any clear direction of my claim. Where is the so-called 2 to 3 days processing time? I don’t know the answer to this except incompetence & deliberate POOR service. Over promise and under delivery.

Thank you.