Discovery Key Care Disappointment

Please note I have submitted the claim to Discovery via the app and online in June 2022 and have note received any feedback to date.

So frustrated with Discovery Key Care Plus, after submitting my claim for a second time and complaining on Hello Peter we received were informed why the claim was not paid as follows:

29: We have not paid the amount claimed, as you have exceeded your annual limit for mental health.
36: This is an adjustment of a claim that we have processed before.


How can we get an authorization number and then not once were we called to be explained how the cover is going to be covered, no case manager nobody said nothing. This was treatment in March 2022 and in June 2022 we get and invoice to say we are behind. Why did no one just pick up a phone and speak to us. Now we are in R 25 000 debt

Discovery Key Care Plus expect from us to walk around with a handbook and we need to know how everything how this medical aid works. I want to speak to someone I want to know how did we exceed our limit?????

The below is on you benefits booklet - now were is says about annual limit for mental health. cover??

Once enrolled on the programme by your network psychologist or KeyCare Premier Plus network GP, you have access to defined cover for the management of major depression. Enrolment on the programme unlocks cover for prescribed medicine, access to either individual or group psychotherapy sessions (virtual and face-to-face therapy) and additional GP consultations to allow for effective evaluation, tracking and monitoring of treatment. Qualifying members will also have access to a relapse prevention programme, which includes additional cover for a defined basket of care for psychiatry consultations, counseling sessions and care coordination services

21 days for admissions or up to 15 out-of-hospital consultations per person for major affective disorders, anorexia and bulimia, and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide. 21 days for other mental health admissions. All mental health admissions are covered in full at a network facility. I

f you go elsewhere, we will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account.

What a frustration, just received the following message from the DR accounts department:

Good day Mr Dr Jager, Kindly note that your medical aid has reversed claim from the 07/03/2022 up till 16/03/2022 to pay other Dr I spoke to Tameryn *** from your medical aid on the 26/07/2022 with regards to this and it was confirmed that the claims have been reversed this means that you are liable for the R7034.80 Kindly advise if you have received the statement that i sent through to you.

Why cant Tameryn from Discovery Key Care medical aid tell us what is going on, WHYwas the claims reversed if a authorization number was provide from Discovery???

What is going on I have been trying to get real answers from Discovery from 14 July 2022.