CD
Candy D

1 reviews | Active since Oct 2010

12 Jan 2024, 08:02

Discovery not paying - AGAIN

I had a procedure authorised for the 23rd November 2023, eustachian tube dilation, grommets and a sinus washout. All was sorted and I had my hospital authorisation and approval for all procedures. Fast forward to 11 December Discovery turn around to me and say "No we need motivation for your (6999) eustacian tube dilation we aren't paying anything". This AFTER I had been for the procedure as i had an authorisation, AFTER I had already paid the doctor out of my pocket R16517. To date over a month later I am STILL waiting for them to advise me what on earth is happening. I have spoken to Anele, Zama and others, the query has been escalated to claims, to clinical etc etc and NO ONE can give me a clear answer on what on earth is happening with the authorisation for the 6999 code. I have probably spent 4hours plus on the line to Discovery. The latest is that they don't now need the doctors motivation as they have an approval on their side - ok, so what are you paying??? Cause right now out of a claim of R16517 you have paid R3k roughly!! R3k?? What the hell am I paying Discovery over R9k a month for if all they pay out of a procedure is 3k and then make me jump through a million hoops to try and find out what should be a simple thing, what are you paying for code 6999?? I had eustachian tube dysfunction, otitis media for 2 years, and the list goes on. We tried EVERYTHING clinically possible to avoid surgery but had to go this route and now I am sitting out of pocket, frustrated and just want someone to sort this out once and for all

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Replies (5)
Discovery Health
Discovery Health's reply12 Jan 2024, 10:00
Official
Dear Candy

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
CD
Candy D's update16 Jan 2024, 10:57
Reviewer Update
Still awaiting a response. Spoke to the agent last week Friday, apparently they have paid accordingly. NO you have completely ignored 1 whole code and after actually looking at the claim she agreed, something about the codes being similar they assumed it was paid. NO look slowly and carefully before you sign something off. Called yesterday again, a message was sent to urgently call me back and nothing.
Discovery Health
Discovery Health's reply16 Jan 2024, 13:47
Official
Dear Candy

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

Regards Discovery Health Servicing Team
CD
Candy D's update16 Jan 2024, 15:08
Reviewer Update
Discovery, you are still incorrect. I was in the middle of an orientation with my girls and the claims statement you have sent is STILL incorrect. You have NOT paid the code in question. I have no cooking clue how you run a business like this?! It's incorrect what she said on the phone vs what the statement says vs what I have been fighting this entire time
Discovery Health
Discovery Health's reply23 Oct 2024, 18:24
Official
Dear Candy

We have been in contact with you.   

Regards Discovery Health Servicing Team