CD
Charmaine D

1 reviews | Active since Oct 2009

05 Feb 2024, 22:46

Discovery in-hospital benefit not covered or covered from MSA (some medication)

We are very appreciative of Discovery paying 97% of our hospital bills since my husband was admitted on 4 November 2023. However, I had to carefully monitor the claims statement to ensure they pay all the health care providers. Some were rejected (1) too new to plan even though we are members for the past 16 years and on this plan for more than 10 years (2) others rejected not covered under plan. However, on other days the same was paid (3) some were paid from our MSA which previously and after the claims were paid from "the scheme". I had to make numerous phone calls to have this resolved. But today, I unfortunately had enough. The invoice submitted by Life Bedford Gardens Hospital had items being paid from my MSA and I was informed it was because the pharmacy provided the ICU with the medication. However, other items from the pharmacy was paid from "the scheme". When I asked as to whether they have a dispute process, the consultant informed me that they don't have such a process and that I will have to address this with a senior. I couldn't believe what I heard. The call was cut off. A few minutes later she phoned me and informed me that there is a dispute form I can submit and then a panel of doctors will review and decide if the items need to be paid from the MSA or "the scheme". Very expensive process. My husband has been in medical facilities for 19 weeks. Of which 95% was in the ICU. The administration burden during this time is not fair.

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Replies (4)
Discovery Health
Discovery Health's reply06 Feb 2024, 07:18
Official
Dear  Charmaine D
 
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 reply19 Feb 2024, 12:13
Official
Dear  Charmaine D
 
We’ve contacted you regarding your complaint. 

Regards 
Discovery Health Servicing Team


CD
Charmaine D's update22 Feb 2024, 11:09
Reviewer Update
Thanks so much Discovery....matter being attended to.
Discovery Health
Discovery Health's reply23 Oct 2024, 18:18
Official
Dear Charmaine D

Thank you for taking time to give us your feedback. 
   
Regards 
Discovery Health Servicing Team