Discovery Sport Injury Benefit on Smart Network Plans

<p>I’m on the Classic Smart Plan and on this plan the following “Day-to-day” benefit is available:</p> <p>>> Cover for sports-related injuries: basic X-rays, two specialist visits and a total of four visits</p> <p>>> to either a physiothe******, biokineticist or chiropractor when referred by a Smart</p> <p>>> Network GP. You will have to pay R100 for each visit.</p> <p> </p> <p>So before I could visit the physiothe****** two things needed to be true:</p> <p>1. I must have a sport related injury. This I have due to running/jogging.</p> <p>2. I must be referred by a Smart Network GP. This I also did. (Dr. Thys Erasmus – Medipark)</p> <p> </p> <p>Before I went to the physiothe****** I confirmed with Discovery (Web Transcript - Ref# ********** 382) that everything is ok for me to see the physio and this was the response:</p> <p>>> SIBUSISO9 : contact the physiothe******s that you find on that list because we dont have</p> <p>>> any network physios. but we will pay up to the Discovery health Rate under the sports</p> <p>>> injury benefit.<br /> </p> <p>So I went to the physiothe****** (GREY, ROLFE, BEZUIDENHOUDT & ASSOCIATES) and Discovery rejected the claim. By many calls, emails and webchats I was given three reasons the claim is not being paid:</p> <p>1. The claim did not had the referring doctor – Fixed by GRB.</p> <p>2. Incorrect ICD-10 codes – Fixed by GRB.</p> <p>3. Sport Injury Benefit was not enabled by referring doctor – Can’t get this fixed.</p> <p> </p> <p>Dr. Erasmus did not know that the Sport Injury Benefit should be enabled as did I and the first few Discovery personnel answering my question on why the GRB claim was rejected.</p> <p> </p> <p>After contacting Dr. Erasmus he did tried to help me. But the Discovery’ Health ID system seems to be a problem and not working. The system SMSed me a One-Time-Pin which Dr. Erasmus had to phone me to get but even then there was a problem.</p> <p> </p> <p>In all this hours spend trying to fix this GRB and Dr. Erasmus was extremely helpful. Discovery on the other hand just seems to keep adding more and more red tape in order to bypass their responsibilities. (Just like how they changed the Vitality rules on April last year.)</p> <p> </p> <p>So why is the physiothe****** not being paid?</p> <p>1. I did everything required of me and more.</p> <p>2. GRB also went out of their way to fix their issues.</p> <p>3. Dr. Erasmus tried to enable the “Sport Injury Benefit” but the Discovery Health ID app is broken.</p> <p>4. Discovery is not assisting, just giving reasons why it is not their fault.</p> <p> </p> <p>Also, Discovery has these four steps if you have a complaint. Step 2 is to contact the Principal Officer which I did almost two weeks ago and no response from the Principal Officer. The only viable option left for me it seems is to skip step 2 and step 3 and directly go to step 4 which is contacting the “Council of Medical Schemes”</p> <p> </p>