LF
Lameez F

1 reviews | Active since Jul 2014

05 Jun 2015, 09:45

Discovery Refusing to Pay Claims for Specialist

i am a keycare member. I pay R4700 a month for medical aid for me and my family. Keycare plus is the lowest plan on discovery but the cover itself is not bad, but limited. I was diagnosed with Graves Disease in January this year by my GP. I had to cover the cost of my blood tests myself. Keycare does not have an Endocrinoligist on their specialists panel but I was given the go ahead to see one at Christiaan Barnard Hospital. My GP followed procedure and app**** for the specialist benefit. each member is given a R3000 annual limit for specialist visits. I went to see my specialist for my first visit in March at a cost of R1400 which I had to pay and then claim back. Discovery sent me an email advising they will cover only R300 of the claim I have yet to receive that refund. I had my follow up appointment in May at a cost of R700, Discovery advised they will not pay but will look into it if I paid a shortfall of R80 that was reflecting on my account, which I paid. they are now saying I did not follow procedure and they will not cover any of the costs, and the specialist benefit i app**** for expired on 22/04. only after my first visit but they didnt even cover that. how is this okay?

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Replies (1)
Discovery Health
Discovery Health's reply05 Jun 2015, 18:10
Official
Hello Lameez19,

Thank you for your comment.

We are investigating your concerns and will be in contact to assist.

Regards
Rishana