KR
Keegan R

1 reviews | Active since Feb 2017

28 Feb 2024, 09:34

Discovery Medical Aid is a Disgrace: Helping Gap covers not pay out Copayments Claims

My wife went for a day procedure at Westville Hospital. She contacted Discovery beforehand and advised them that we will be paying the copayment at Westville Hospital, in cash and will claim it back from our Gap cover (Kaelo) and we don't want them to use our day-to-day savings. A Discovery employee named Sally Anne agreed to the terms. At Westville hospital reception I paid a copayment of R3 050.00. Days later I had a look at the claims on my app and discovered that Discovery had also paid the copayment from my day-to-day savings. My wife contacted Sally Anne to enquire about this, as She and my wife had a verbal agreement not to use our day-to-day savings for the copayment. she advised she will sort it out. after I couple days after getting no feedback from Sally Anne, my wife contacts her. She tells my wife she cannot do anything; Westville hospital will refund the cash to me, and that the copayment will come out from the day-to-day savings. Now, my medical day-day savings is down R3 050.00, also gap cover is not compensating me for R3 050, as Westville hospital was directed by Discovery to refund me. It looks like Discovery is helping Gap cover companies not to pay out copayments claims by paying copayments out of the patient's day-to-day savings without their consent.

0
Replies (12)
Discovery Health
Discovery Health's reply28 Feb 2024, 10:39
Official
Dear Keegan R

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 reply28 Feb 2024, 13:50
Official
Dear Keegan R

We have been in touch with you to answer your comments.
   
Regards 
Discovery Health Servicing Team
KR
Keegan R's update01 Mar 2024, 11:56
Reviewer Update
The matter has still not been resolved, as I have done whatever I was told to do.
KR
Keegan R's update13 Mar 2024, 16:39
Reviewer Update
I was instructed by a discovery employee to pay the hospital more money to match the amount discovery paid to the hospital , thereafter I will be refunded my day to day funds and also claim my co payment from gap cover.it has been several days now and my day to day funds has not being refunded,nor has discovery contacted me. Discovery is becoming very hard to deal with and are becoming ****s.
KR
Keegan R's update14 Mar 2024, 16:18
Reviewer Update
Discovery medical aid is a wolf in sheep clothing.Discovery staff are trained to lie and manipulate the client's, so they rob their client's of their funds.I will be handing over this matter to the ombudsman and thereafter my team of lawyers, if this is not resolved today.
KR
Keegan R's update19 Mar 2024, 06:39
Reviewer Update
Matter resolved
Discovery Health
Discovery Health's reply26 Mar 2024, 16:42
Official
Dear Keegan R

Thank you for the feedback.
   
Regards 
Discovery Health Servicing Team


KR
Keegan R's update18 Mar 2025, 08:29
Reviewer Update
This problem was resolved one year ago, Now Westville Hospital, is calling me and harassing me for money, as Discovery reversed the payment, I will send this matter to my lawyer,if this matter is not sorted out. You can't call me one year after and demand money from me, when this was sorted out last year.
KR
Keegan R's update18 Mar 2025, 08:35
Reviewer Update
I have proof emails and statements, as this matter was resolved.I have called my lawyer and he had advised me.discovery is committing fruad. If they are resolving a matter and later on going back and reversing their payment,as this was a special case.
Discovery Health
Discovery Health's reply25 Mar 2025, 14:14
Official
Dear Keegan R

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
KR
Keegan R's update25 Mar 2025, 14:25
Reviewer Update
You can investigate .I won't be liable for anything, as this should have been brought to my attention, immediately. I will be taking legal action,if this matter is not resolved. An employee at life hospital or discovery made a mistake and now you guys want to pin it on me.
Discovery Health
Discovery Health's reply27 Mar 2025, 17:11
Official
Dear Keegan R

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team