1 reviews | Active since Feb 2022
Discovery not authorising PMB's
Good Day
I am absolutely shocked and disgusted with the medical aid. I been with Discovery for many years (I have had breaks in between), however my daughter has been the one that has been traumatized and this is not acceptable. Firstly, we went to see the GP at the end of January for the first time since joining the medical aid for headaches that had just started. He referred me to a peadiatrician. however due to error from discovery side, it said there was an error in the referral on the system and that we should try again. in the process I made an appointment with the peadiatrician and we paid out of our own pocket to see her. she then contacted me and told me that I need to bring my daughter in to casualty and have her admitted. She gave me a referral. The casualty visit was authorised. They then requested an authorisation for admission into the ward. This auth. was then pending. Between many phonecalls from my side as well as the hospitals side, we had received an emergency 24hr authorisation. We were first told that to get auth we had to see the casualty dr. we saw the casualty dr who said she must be admitted, then discovery came back and said that now they need to get information from our long standing GP. I informed them that we have not seen that GP in about 4 years. Then they said what about current GP.Ii informed them that the current Dr has only seen my daughter once which was for these issues. I then got an sms stating that the forms have been sent to our new gp. I contacted discovery again and I informed him that this GP will not be able to give any information about my daughter as she has only seen him once. All 3 people I spoke to told me they will follow up with the gp etc. and they all mentioned the new GP. I informed them many times yesterday that the GP cannot give them any information. I was told that they would then send it to my long standing GP even though they are aware that She has not seen the GP in about 4 years. They said they will follow up yesterday and they would follow up today. I tried calling however after spending over R300 in calls to discovery yesterday I did not have enough airtime to hold to get through to them I received a call from discovery telling me that they have not received the forms that they requested from the new GP. This got me angry because I informed her and the other 2 ladies that her long standing GP is the other dr. So now because discovery did not listen to me, nor did they follow through like they said they would. As stipulated we have a 24 hour auth. and now discovery has wasted a day where it would have been an extra day for the case to be reviewed in ORDER FOR DISCOVERY TO SEE THAT THIS IS NOT AN UNDERLYING CONDITION and that it is a legitimate condition that has just developed. Now with the 24 hour delay by discovery, we are now sitting unsure of what will happen from here out. They told me yesterday that it might be an idea to take my daughter home and wait for authorisation. I requested it be put in writing of which they refused to do such. They were pushing the responsibility onto the hospital. At no time was I ever informed that I have a waiting period for PMB's or a clause on the PMB's. As far as I am aware that no matter what plan you are on, that you are covered for all pmb's. All of a sudden this was not adhered to,. It just seems that Discovery is just trying to make excuses to ensure that this auth. does not go through. There is still a lot more to this, however this complaint will go on and on. But I need urgent response to this. If you need any personal details I will send them privately through.
Kind Regards Jolene
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
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
