DB
Daniëlle Botha
1 reviews | Active since Jul 2018
10 Mar 2020, 12:22
Discovery Keycare Not covering Emergencies
I was hospitalized on 25/02/2020 with a Torn Ligament in my Left foot. (EMERGENCY) The doctor sent me for x-rays, and started medication, i was admitted and treatment commenced. But it was NECESSARY for a moonboot for 6 weeks. (Without it the injury would not heal)
Now I want to know - Since I Reside in Thabazimbi and according to Discovery they will not pay for my moonboot (That i need for the next 6 weeks) because it is not a preferred provider???????
Why do you offer medical aid in this region? Due to my Injury and the fact that it was an emergency i was not able to travel to my nearest "PREFERRED PROVIDER" which is two hours away. Since Thabazimbi only has ONE hospital
When phoning Discovery - the voice on the call stipulates that in case of EMERGENCY go to your nearest HOSPITAL - WHICH IS WHAT I DID.
Please explain to me how you cover a hospital stay but would not cover the one item I desperately need to recover?
So its fine to be hospitalized but from there on I am on my own?
I've been on this medical aid for three years - this was the first time i've been admitted and with an emergency! And Discovery doesn't even want to cover the cost of the one item i need for my healing process?? But they cover the hospital visit?
I am deeply upset with Discovery Health Keycare Plus!
Ive been a devoted member of Discovery and this is the payback I recieve.
Helpful (0)
Replies (3)0
Replies (3)
Discovery Health's replyOfficial
10 Mar 2020, 15:02Dear Daniëlle B
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's reply10 Mar 2020, 15:02
Official
Dear Daniëlle B
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's replyOfficial
11 Mar 2020, 16:21Dear Daniëlle B
We’ve contacted you regarding your complaint.
Regards
Discovery Health Servicing Team
Discovery Health's reply11 Mar 2020, 16:21
Official
Dear Daniëlle B
We’ve contacted you regarding your complaint.
Regards
Discovery Health Servicing Team
DB
Daniëlle Botha's updateReviewer Update
12 Mar 2020, 16:15To the RUDE lady who just phoned me from Discovery at *** at 13h20 - stating that Discovery will not pay for my moonboot since according to her this is not a "treatment" for a torn ligament and that it is an exclusion also stating the network provider issue.... That it is not her issue that I moved to a town where there is not a network provider - and that it wouldve been advised to drive to my nearest hospital - ( 2 HOURS DRIVE - WITH A TORN LIGAMENT) Lady Also clearly asking me to change my post on Hello Peter - since i did not MAKE IT CLEAR ENOUGH THAT DISCOVERY PAID FOR MY HOSPITAL STAY - AND THAT IM UPSET BECAUSE THEY DO NOT WANT TO PAY FOR MY MOONBOOT (TREATMENT OF REASON WHY I WAS ADMITTED) because it is an "exclusion" I rather shouldve gotten crutches? - But ive been a loyal member for 3 years and its okay to treat me like SH@T??!! When I actually NEED to use my medical aid ive been paying estimate 36 x R1456.00 per month = 52 416 for three years - ITS TOO much to ask for them to cover a Moonboot "walker" as described by orthopaedic department for R1679.20 once???
So NO i will not "change" my post - i rather pin point the unfairness of the whole situation and horrid service.
I also did my homework:
Please refer to Discovery Health Medical Scheme Keycare series guide:
Page 8:
"Emergencies are covered in full. If you have an emergency, you can go straight to hospital." (THATS WHAT I DID)
Page 10:
Under medical equipment:
On Keycare Plus - we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and WALKERS on the medical equipment list, if you get them from a network provider. (NETWORK PROVIDER 2 HOURS AWAY - EMERGENCY) There is an overall limit of R5 400 for each family. (Moonboot "walker" is R1679.20) ????????
Schuch Ortopaedic Services Claimed:
1 x FP WALKER under S86.0, S96.8 X50.19 For R1679.20.
I do not see why you are making such a big fuss for me as a patient being upset for Discovery making excuses not to pay for my treatment.
Please also refer to Medical schemes act of 1998 (Act no 131 of 1998) and its regulations:
- All medical schemes have to cover the costs related to the diagnosis, treatment and care of: - an EMERGENCY medical condition.
I can always send you the Medical schemes act showing that the Musculoskeletal system is included under PMB
So NO i will not "change" my post - i rather pin point the unfairness of the whole situation and horrid service.
I also did my homework:
Please refer to Discovery Health Medical Scheme Keycare series guide:
Page 8:
"Emergencies are covered in full. If you have an emergency, you can go straight to hospital." (THATS WHAT I DID)
Page 10:
Under medical equipment:
On Keycare Plus - we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and WALKERS on the medical equipment list, if you get them from a network provider. (NETWORK PROVIDER 2 HOURS AWAY - EMERGENCY) There is an overall limit of R5 400 for each family. (Moonboot "walker" is R1679.20) ????????
Schuch Ortopaedic Services Claimed:
1 x FP WALKER under S86.0, S96.8 X50.19 For R1679.20.
I do not see why you are making such a big fuss for me as a patient being upset for Discovery making excuses not to pay for my treatment.
Please also refer to Medical schemes act of 1998 (Act no 131 of 1998) and its regulations:
- All medical schemes have to cover the costs related to the diagnosis, treatment and care of: - an EMERGENCY medical condition.
I can always send you the Medical schemes act showing that the Musculoskeletal system is included under PMB
DB
Daniëlle Botha's update12 Mar 2020, 16:15
Reviewer Update
To the RUDE lady who just phoned me from Discovery at *** at 13h20 - stating that Discovery will not pay for my moonboot since according to her this is not a "treatment" for a torn ligament and that it is an exclusion also stating the network provider issue.... That it is not her issue that I moved to a town where there is not a network provider - and that it wouldve been advised to drive to my nearest hospital - ( 2 HOURS DRIVE - WITH A TORN LIGAMENT) Lady Also clearly asking me to change my post on Hello Peter - since i did not MAKE IT CLEAR ENOUGH THAT DISCOVERY PAID FOR MY HOSPITAL STAY - AND THAT IM UPSET BECAUSE THEY DO NOT WANT TO PAY FOR MY MOONBOOT (TREATMENT OF REASON WHY I WAS ADMITTED) because it is an "exclusion" I rather shouldve gotten crutches? - But ive been a loyal member for 3 years and its okay to treat me like SH@T??!! When I actually NEED to use my medical aid ive been paying estimate 36 x R1456.00 per month = 52 416 for three years - ITS TOO much to ask for them to cover a Moonboot "walker" as described by orthopaedic department for R1679.20 once???
So NO i will not "change" my post - i rather pin point the unfairness of the whole situation and horrid service.
I also did my homework:
Please refer to Discovery Health Medical Scheme Keycare series guide:
Page 8:
"Emergencies are covered in full. If you have an emergency, you can go straight to hospital." (THATS WHAT I DID)
Page 10:
Under medical equipment:
On Keycare Plus - we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and WALKERS on the medical equipment list, if you get them from a network provider. (NETWORK PROVIDER 2 HOURS AWAY - EMERGENCY) There is an overall limit of R5 400 for each family. (Moonboot "walker" is R1679.20) ????????
Schuch Ortopaedic Services Claimed:
1 x FP WALKER under S86.0, S96.8 X50.19 For R1679.20.
I do not see why you are making such a big fuss for me as a patient being upset for Discovery making excuses not to pay for my treatment.
Please also refer to Medical schemes act of 1998 (Act no 131 of 1998) and its regulations:
- All medical schemes have to cover the costs related to the diagnosis, treatment and care of: - an EMERGENCY medical condition.
I can always send you the Medical schemes act showing that the Musculoskeletal system is included under PMB
So NO i will not "change" my post - i rather pin point the unfairness of the whole situation and horrid service.
I also did my homework:
Please refer to Discovery Health Medical Scheme Keycare series guide:
Page 8:
"Emergencies are covered in full. If you have an emergency, you can go straight to hospital." (THATS WHAT I DID)
Page 10:
Under medical equipment:
On Keycare Plus - we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and WALKERS on the medical equipment list, if you get them from a network provider. (NETWORK PROVIDER 2 HOURS AWAY - EMERGENCY) There is an overall limit of R5 400 for each family. (Moonboot "walker" is R1679.20) ????????
Schuch Ortopaedic Services Claimed:
1 x FP WALKER under S86.0, S96.8 X50.19 For R1679.20.
I do not see why you are making such a big fuss for me as a patient being upset for Discovery making excuses not to pay for my treatment.
Please also refer to Medical schemes act of 1998 (Act no 131 of 1998) and its regulations:
- All medical schemes have to cover the costs related to the diagnosis, treatment and care of: - an EMERGENCY medical condition.
I can always send you the Medical schemes act showing that the Musculoskeletal system is included under PMB