Discovery Health: why is it always a battle for them to pay claims!

Earlier this year, I gave birth by emergency c-section and had the in-house pediatrician in attendance at the birth, as is procedure. This is all supposed to be covered by the hospital benefit on my Discovery Health plan.

Upon submission of the paediatrician account to Discovery, Discovery rejected the claim. When I followed up, Discovery admitted the error and advised they would pay.

When Discovery paid, they only paid for the account in part. When I followed up with the paediatrician to find out why Discovery may have only paid for part of the account, the account lady advised that the account should have been paid in full Discovery as part of the PMB, but that Discovery nearly always short pay patients' accounts in this way. She advised that with a letter of motivation from the gyn/ob and the pediatrician, she would submit the claim to Discovery again and the shortfall on the account should be paid.

The shortfall submission took another 2 weeks of follow up's with Discovery for them to pay the shortfall and all in all, it took a month of follow up's for Discovery to pay in full what is was supposed to pay in full the first time round. And had I not followed up at all, Discovery would have got away with not paying anything of what they should have covered in full in the first place! Frankly, this behaviour disgusts me!

By way of comparison, when it came to adding my child as a dependent, the procedure was done in a couple of days!

Thus, it can be summarized that when it comes to taking patients money (eg. for a new dependent), Discovery act in a couple of days, but when it comes to rightfully paying patients' claims, Discovery first withhold rightful payment to patients and then it's a battle that that takes a month of documents and followup's on the part of the patient for Discovery to pay!

Discovery take my premiums very promptly every month and yet its a battle to get them to do the right thing and pay what is rightly due to me.

And this is not the first time I have recently battled with Discovery to get them to pay claims. In my pregnancy, they authorized a claim and then proceeded to reject it 5x! I spent a stressful and agonizing month following up and fighting with Discovery to get the claim sorted. It is again most disappointing that a pregnant member must get stressed and battle to get Discovery to pay what they should have already paid upfront.

And speaking to friends who are Discovery members, it is clear, Discovery treat them as poorly as they have treated me.

Why is dealing with Discovery always such a fight!?

I find this behaviour most disappointing: it is is dishonorable and lacks integrity. Are these the kind of values Discovery stands for?

And it makes me wonder how many other times have Discovery not paid or short paid me? Do I have to go through my account with a fine tooth comb and ask every time: why is this not paid? why is there a shortfall? And how many other members does Discovery rob in this way?

I am beginning to find my constant battles with Discovery not worth the effort and maybe I should look elsewhere for my medical insurance.

Very, very disappointing Discovery - let others be warned of your lack of honour and integrity.