TS
Tamaryn S

1 reviews | Active since May 2016

10 Jan 2024, 20:25

Discovery makes it increasingly difficult for healthcare providers to provide essential services to their members

As a healthcare provider Discovery has always remunerated me directly for services provided to their clients. This year without communication Discovery is making payments directly to members. Emails inquiring about this remain unanswered and unhelpful phone calls where I have been given different messages such as I have to give Discovery my banking information (even though they’ve paid me directly for over 4 years) or as a clinical psychologist I fall under al**** services and therefore I can’t be remunerated directly. However payments are still being received from medical aids administered by Discovery. This makes no sense.

Discovery has been one of the few medical aids who always remunerated their providers directly and promptly which is why I only claim directly from Discovery on behalf of the member. It’s very disappointing that they are making it increasingly difficult to be remunerated for essential services rendered to their members. And as a member of Discovery myself, I have found it increasingly difficult for Discovery to reimburse me for claims paid cash. I only seem to be paid in full if claims are submitted through a broker.

Discovery has always paid me as a provider so I could oversee the difficulty in being reimbursed as a member however it may be time to rethink using Discovery as a provider as well as a member.

It appears as though Discovery is making it more difficult to use the medical aid.

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Replies (5)
Discovery Health
Discovery Health's reply11 Jan 2024, 06:59
Official
Dear Tamaryn S

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
TS
Tamaryn S's update11 Jan 2024, 17:42
Reviewer Update
Discovery has responded to this matter and is not satisfactory.

Please note that your response and approach to payment is not in the best interest of the patient nor ensuring that the provider is paid for essential services as you claim. In addition by only having Direct Payment Arrangements for Specialist Providers or General Practitioners is discriminating against other providers providing services to your members.

As a member of Discovery I have submitted claims and Discovery has covered the scheme rate and I had to settle the account with the provider if they charged above scheme rates. Why can Discovery not pay the scheme rate directly to all providers and the member settle the account? Why can this only be done with certain providers?

Discovery does not take into account the qualification level and categories of the different psychologists and this is why I am forced as a provider to charge a higher rate. As a clinical psychologist I have gone through a very strenuous section process to get into a masters programme, I have completed internship and community service the same as all medical professionals. In addition, according to the Health Professionals Council of South Africa (HPCSA) all practitioners are required to charge the same rate for the same procedure. As a practitioner I cannot charge different rates to suit the medical aid and ensure payment is received.

Discovery's approach to this matter has caused distress to your members and it disregards the specialised training of providers.


Discovery Health
Discovery Health's reply11 Jan 2024, 21:20
Official
Dear Tamaryn S

Please check your emails for feedback from us.

Regards
Discovery Health Servicing Team

TS
Tamaryn S's update11 Jan 2024, 22:39
Reviewer Update
That is the response to your feedback. Not only is Discovery causing more distress to members who are already in a very vulnerable space but they are also discriminating against practitioners who are only trying to comply to the Health Professionals Council of South Africa’s guidelines.

Discovery is making it difficult for members to receive essential services by hindering payment to providers. Indirectly forcing members to pay cash when they have medical aid benefits.
Discovery Health
Discovery Health's reply06 Dec 2024, 12:03
Official
Dear  Tamaryn S

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