RS
Rejoice S

1 reviews | Active since Jan 2022

12 Jan 2022, 09:32

Discovery Remedi Medical Aid(Not fully covered my family)

I was on Discovery Remedi Medical aid at the time the claim happened. My son, Noah Sykes was admitted for the first time in hospital - Bloemfontein Mediclinic. The doctors did not know what was the cause of my son's seizures and said that it was a bacterial infection. Many tests were performed or done on my son, which was very traumatic for him. Including blood tests. He was later diagnosed with epilepsy. I thought Remedi would cover all tests done on my son as this was not mentioned or on contract agreement as an exclusion. We thought all blood tests were covered by Remedi. It was a horrible time for us as a family and we were under alot of stress and my son spent two weeks in hospital. I was later retrenched from the hospital I worked at in March so I had to leave Discovery Remedi Medical aid. I never heard from Remedi as to why these blood tests were not covered, I had to quickly change to a new Medical aid and a cheaper one, as I did not have an income. My son was on chronic medication and we need medication every month for him. I did receive a call from Pathcare last year about this account and i explained to the accounts department lady that i can't afford to pay that account i am unemployed and Discovery Remedi must pay for it, i was on Comprehensive cover all tests had to be done to investigate want was wrong with my son. I am now with a cheaper Medical Aid Medshield( Mediphila) and all my sons treatments and tests are covered, he has full PMB Bennifits and I am so happy we found out about Medsheild. I was paying almost R7000.00 with my employee contribution with Discovery Remedi and they cant cover a few tests????? I pay half of that premium now with Medsheild!!

Path care never told me that they will by handing me over, Yesterday 11/01/2022 I received a letter from lawyers stating that I have been handed over by pathcare for tests done in December 2019 on Discovery Remedi Medical aid(***). The lawyers are Vericred Collection in Bloemfontein - ***. An amount of R9466.75 is being asked from me?? How and why can I pay this ??????? Discovery lines are always busy i cant get help and you get directed to so many people they lose you in their calls?? I don't know what to do as i cant afford this now!

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Replies (6)
Discovery Health
Discovery Health's reply12 Jan 2022, 10:10
Official
Dear Rejoice S
 
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 
RS
Rejoice S's update12 Jan 2022, 10:23
Reviewer Update
To your response, this is what Pathcare has sent me for my complaint. Who is liable? Why was claim rejected??? I dont have that money.

Dear Mrs Sykes.
Thank you for elaborating on the situation and for forwarding me the information.
I am truly sad to hear about the challenges you have faced during the diagnosing period of Noah Sykes and everything else since his diagnosis.
With regards to the hand over, due to non-payment, we as pathologist cannot w/off our pathology services rendered and no payment arrangement being made by you. The hand over to the collections attorney was regrettably the next step in our collections process.
The communication our accounts offices have sent you with regards to your medical aid Remedi not setting these types of test is correct.
This rejection by Remedi medical aid at the time which is still in effect, was a decision made by the Medical aid scheme themselves and not PathCare Pathology.
As pathologist , we proceed with test as requested by the treating clinician(s), thus as pathologist we render our services in good faith that we will be paid for these services , either by the medical aid or by the member should the medical aid not pay for reasons they have actioned in house.
Regrettably, we cannot waive the costing of the test done in the amount of R8,871.00 , this has to be paid to the pathologist for services rendered. I can ask for a retraction from the agency and to waive the legal cost that was added to the billing. The amount due as mentioned above can be paid over 3 or 6 months , I can extend the payment period to 8 months
With regards to Remedi medical scheme, I have to refer you to them as I cannot speak or comment on their behalf with regards to their decision for non-payment of test.
Yours sincerely
Sharon van der Berg
Senior Technical Specialist (Admin)
Tel no: ***

Discovery Health
Discovery Health's reply13 Jan 2022, 10:54
Official
Dear Rejoice S
 
We contacted you to discuss your query.
 
Regards 
Discovery Health Servicing Team
RS
Rejoice S's update14 Jan 2022, 12:42
Reviewer Update
I don't have one missed call from Discovery Health???

If you really did investigations , you would email/or call me.

I will give you my contact details.
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RS
Rejoice S's update17 Jan 2022, 19:40
Reviewer Update
Discovery has not contacted me , that is lies! I’m still waiting for your call or email?????? Absolutely useless.
RS
Rejoice S's update19 Jan 2022, 09:17
Reviewer Update
1 week later and no calls or emails from Discovery, I will be taking this matter further.