Discovery query

<p>Discovery is providing parthetic service</p> <p>I'm still waiting for the response of My query from Discovery where I was charged for Gscope while I was hospitalised. Authorisation was only done after I was discharged so I was not informed that this will be charged from my savings. I want an amount of R3900.00 to be reversed back to my account </p> <p>They were quick to close my first Hello Peter query without resolving it </p> <p>I dont want to deal with PERUSA any more as she is VERY VERY ***********</p> <p>SEE EMAIL BELOW</p> <p> </p> <p>From: ********** ********** <br /> Sent: 12 April 2017 10:06 AM<br /> To: Ruth Nobahle Mgoboza<br /> Subject: RE: Membership number: ********** 10 -WRefNo# ********** 003#- -MailRef# ********** 184#-</p> <p> </p> <p> </p> <p>Dear Miss Mgoboza</p> <p>Thank you for contacting us. </p> <p>Request for endoscopic (scope) report</p> <p>As discussed telephonically on 29/03/2017, we confirmed we will request the scope report from Dr Sebele’s rooms. We also explained that we cannot confirm a response time for this request, because it is dependent on when we receive the report from your doctor.</p> <p>We assured you that would contact you within 2 to 3 working days, after we receive the report.</p> <p>We called Dr Sebele’s rooms on 011 ********** , and spoke to Mandy on the following dates:</p> <p>29/03/2017<br />05/04/2017<br />11/04/2017<br />We have still not received the scope report. Mandy stated that she cannot confirm when Dr Sebele will write the report however she will discuss it with him today (12/04/2017).</p> <p>I have given Mandy our fax number and my email address.</p> <p>Should you have further queries on this you can email ********** For all other queries, please call us on ***or email ********** Alternatively, you can access the website at www.discovery.co.za</p> <p>Regards<br /> Paurusa Nadrajah <br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p><br />RE: Membership number: ********** 10 -WRefNo# ********** 865#- -MailRef# ********** 139#-<br /> <br />To: "<br ********** ********** RE: Membership number: ********** 10 -WRefNo# ********** 865#- -MailRef# ********** 139#-<br />From: Ruth Nobahle Mgoboza ********** />Date: Mon, 10 Apr 2017 15:30:34 +0200 (CAT)<br />Accept-language: en-ZA, en-US<br />Delivered-to: f ********** ********** />In-reply-to: < ********** 018.422498. ********** ********** />References: < ********** 018.422498. ********** ********** />Resent-from: ********** />Thread-index: AQHSp5pNGpSS0qyatE2GxifCaEDwiKG+ra5w<br />Thread-topic: Membership number: ********** 10 -WRefNo# ********** 865#- -MailRef# ********** 139#-<br /> <br />Good day Perusa</p> <p> </p> <p>Following my Hello Peter query, you promised to get back to me once you get the G Scope report from the doctor.</p> <p>I’m still waiting for the response</p> <p> </p> <p>Regards</p> <p>Ruth</p> <p> </p> ********** ********** <br /> Sent: 28 March 2017 10:08 AM<br /> To: Ruth Nobahle Mgoboza<br /> Subject: RE: Membership number: ********** 10 -WRefNo# ********** 865#- -MailRef# ********** 139#-</p> <p> </p> <p> </p> <p>Dear Miss Mgoboza</p> <p>Thank you for contacting us. </p> <p>Co-payment for endoscopic (scope) procedures</p> <p>As explained in our previous email,we did not confirm the co-payment to you before you were admitted on 28/01/2017, because we received the authorisation request from Tshepo-Themba Private Hospital on 30/01/2017.</p> <p>As a healthcare funder, we decide about funding treatments to ensure we can cover claims now and in the future. We also aim to ensure that members of Discovery Health Medical Scheme have access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design. </p> <p>We have processes in place for members to request funding as an exception, outside of the defined benefits. We would like to reassure you that we will review your request further, upon receipt of the scope report.</p> <p>If you have any further queries, you can email ********** <p>Regards<br /> Paurusa Nadrajah <br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p><br />RE: Membership number: ********** 10 -WRefNo# ********** 699#- -MailRef# ********** 412#- <br /> <br />To: "<br ********** ********** Subject: RE: Membership number: ********** 10 -WRefNo# ********** 699#- -MailRef# ********** 412#- <br />From: Ruth Nobahle Mgoboza ********** <br />Date: Mon, 27 Mar 2017 14:34:05 +0200 (CAT) <br />Accept-language: en-ZA, en-US <br />Delivered-to: f ********** ********** />In-reply-to: < ********** 96.282785. ********** ********** <br />References: < ********** 96.282785. ********** ********** <br />Resent-from: ********** <br />Thread-index: AQHSpvIsZJPf3CR/GkC9ePRdlI+lvKGom0QA <br />Thread-topic: Membership number: ********** 10 -WRefNo# ********** 699#- -MailRef# ********** 412#- <br /> <br />Good day Perusa</p> <p> </p> <p>You are ignoring my complaint and my facts here. You are sending me something that I received after I laid complaint with you.</p> <p>MY POINT IS I WAS NOT ADVISED OF THIS BEFORE THE G SCOPE WAS DONE. You are confirming that the information was made available to me on the 25/02/2016. </p> <p>This is after the scope was done. You mentioned that you explain the cover to me before the preauthorisation is done. Why was this information not explained to me</p> <p> </p> <p>By ignoring my complaint, you leave me no choice but to take this matter up with Hello Peter and Consumer complaints.</p> <p> </p> <p>Regards</p> <p> </p> <p> </p> ********** ********** <br /> Sent: 27 March 2017 02:04 PM<br /> To: Ruth Nobahle Mgoboza<br /> Subject: RE: Membership number: ********** 10 -WRefNo# ********** 699#- -MailRef# ********** 412#-</p> <p> </p> <p> </p> <p>Dear Miss Mgoboza</p> <p>Thank you for contacting us. </p> <p>Cover for endoscopic (scope) procedures</p> <p>On your plan, we cover scopes performed in-hospital, as follows:</p> <p>The first R3 900.00 of the hospital account is paid from the Medical Savings Account (MSA) <br />The balance of the hospital account is paid from the Hospital Benefit (HB) <br />Related accounts are paid from the HB <br />All accounts are paid up to 100% of the DHR. <br />This is subject to preauthorisation and our Scheme rules. <br />This applies to all diagnostic scopes, regardless of the reason you are admitted <br />This information is made available to our members and financial advisers at the time of joining, as well as annually. When you contact us to preauthorise a procedure, we also explain your cover to you.</p> <p>We emailed your health plan guide, to ********** on 25/02/2016. We also emailed your year-end revision letter to this email address, on 11/10/2016. This email included links to our website, for more information on our plans.</p> <p>Please refer to page 8 of the attached guide, which states that the R3 900.00 is payable from the MSA. We refer to this amount as a co-payment.</p> <p>We could not confirm this information to you before you were admitted, because we received the authorisation request from Tshepo-Themba Private Hospital on 30/01/2017.</p> <p>Reviewing funding of the co-payment from the HB</p> <p>As discussed on 22/02/2017, we paid the claim correctly however you may send us the scope report so we can review funding from the HB as an exception.</p> <p>Discovery Health Medical Scheme has a responsibility towards our members, to ensure that we fund healthcare services in line with the benefits available. We are available to assist with all claim queries however it remains the members’ responsibility to ensure that their claims are paid.</p> <p>Kindly note that we contacted your doctor to request this report, on 24/02/2017.</p> <p>If you have any further questions on this, you can email ********** <p>Regards<br /> Paurusa Nadrajah <br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p><br />RE: Membership number: ********** 10 -WRefNo# ********** 564#- -MailRef# ********** 186#- <br /> <br />To: "<br ********** ********** Subject: RE: Membership number: ********** 10 -WRefNo# ********** 564#- -MailRef# ********** 186#- <br />From: Ruth Nobahle Mgoboza ********** <br />Date: Thu, 23 Mar 2017 14:00:20 +0200 (CAT) <br />Accept-language: en-US <br />Delivered-to: f ********** ********** />In-reply-to: < ********** 02.97374. ********** ********** <br />References: < ********** 02.97374. ********** ********** <br />Resent-from: ********** <br />Thread-index: AQHSoxi6zleXDEbAHkCqjVv***A5FKGiUQGw <br />Thread-topic: Membership number: ********** 10 -WRefNo# ********** 564#- -MailRef# ********** 186#- <br /> <br />Good day Perusa</p> <p> </p> <p>My query is the fact that the G-Scope was done and was charged on my savings while I was hospitalised.</p> <p>I was not informed of this before the scope was done. I hear you when saying the clinical department cannot use doctor’s motivational letter to review my claim however none of this is my fault.</p> <p>I cannot provide you with the scope report, only the doctor can do that. Why does it seems as if I will suffer for what the medical aid and the doctor did i.e. medical aid failing to inform me of the charges when the authorisation was requested and the doctor failing to provide you with the scope report.</p> <p> </p> <p>I’m a discovery client and the doctor’s patient. What is happening between the medical aid and the doctor is none of my business. I’m in NO position of providing you with what is needed to review the claim however I cannot accept the fact that I was charged from my savings while I’m in hospital.</p> <p> </p> <p>I think it is your job to find this report not me. What I want is my savings reinstated because I was in hospital and I was given no choice to decide whether I’m proceeding with the scope or not which was the doctors’ orders</p> <p> </p> <p>Can this money be reinstated to my savings otherwise I will have to take this matter further.</p> <p> </p> <p>Regards</p> <p>Ruth</p> <p> </p> <p> </p> ********** ********** <br /> Sent: 22 March 2017 04:30 PM<br /> To: Ruth Nobahle Mgoboza<br /> Subject: Membership number: ********** 10 -WRefNo# ********** 564#- -MailRef# ********** 186#-</p> <p> </p> <p> </p> <p>Dear Miss Mgoboza</p> <p>Thank you for contacting us. </p> <p>Claim query for Tshepo-Themba Private Hospital – reference number: ********** 677</p> <p>Please note that our Clinical Department is unable to review your claim further, because the document we received is a letter of motivation. We require the scope report.</p> <p>A scope report includes details such as the clinical findings and the diagnosis.</p> <p>You are welcome to send the report to ********** and you will receive feedback within 2 to 3 working days.</p> <p>Should you have further queries on this you can email ********** For all other queries, please call us on ***or email ********** Alternatively, you can access the website at www.discovery.co.za</p> <p>Regards<br /> Paurusa Nadrajah <br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p><br /> <br /> <br /> <br /> <br /> </p> <p><br /> <br /> <br /> </p> <p><br /> <br /> <br /> <br /> <br /> </p> <p><br /> </p>