1 reviews | Active since Sept 2011
Discovery trying to low ball me and not pay out despite me proving my point(s)
Discovery trying to low ball me and not pay out despite me proving my points. When you send them the info they want, they will wait a few weeks and then ask you for the same photos they already have then immediately close the claim.
Here are the email communications. Maybe someone else can make sense of my English here and explain to Discovery, I cannot provide information that does not exist. I cannot go in a time machine, make sure my injuries occurred in the time slots they expect and then travel back to current times and send them prove it existed 30 days instead of existing for 2 days. What a shame .. how insulting to someone who has had his policy for over a decade. This is beyond cheap and insulting. Every month for the past decade, when you took your premiums, who knew you would try so hard to low ball me?
Good Day
It's been over 2 weeks and nobody has even bothered to respond yet when you are "missing" information you want, you instantly respond and close the claim.
Companies need to be paid and dragging your feet in this matter is really unprofessional.
Regards, Mr Jimmy
On Thu, Oct 6, 2022 at 2:09 PM Kaveek Jimmy <***> wrote: ---------- Forwarded message --------- From: Kaveek Jimmy <***> Date: Wed, Sep 14, 2022 at 10:53 AM Subject: NPWT Claim info To: <***> Cc: Dr Mark Human Inc <***>, <***>, <***>, <***>
Good Day
Kindly find the LOM for the NPWT I had administered on me on my last visit to the hospital. I did see communications stating this treatment claim was declined with the reason being Discovery wants to see normal wound care treatment for 30 days before the NPWT was app****.
This is very concerning to me for several reasons. Firstly, it is clear that whoever had made such a statement did not take 5 mins to go through my individual case or they would have seen that there was no such wound to dress 30 days prior to this last surgery. Yes my ankle was worked on from the very first surgery on the 18th of May 2022 & I had been in again to stitch my finger. During this time Dr Human debrided my ankle and put it into a cast. I was meant to see him 2 & a half weeks later to open the finger and ankle. The Wednesday before my appointment, exactly 2 weeks later, I noticed a foul smell coming from my ankle and opened the dressing to find a massive gash in my foot accompanied by a foul smell and lots of discharge. I contacted Claudia, the Dr's admin lady and she showed the pics to Dr who immediately stated he needs me in surgery on Saturday and in the interim I need to have a wound care specialist clean the wound.
I went to Holistic Wound care on Thursday and then Friday. Saturday I was in for surgery. I was in hospital till Monday when the wound care specialist Terry came out to me to fit the dressing and I was then discharged.
At no point in this entire dilema did I think to ask Discovery permission or get additional authorization for something that was part and parcel of the entire operation and recovery process. It was not as if the Dr and I decided to hook up a machine 24/7 to me for the fun of it. Or to ****** money from my medical scheme. I had a very difficult recovery process. Having a machine sucking out excess moisture from a very open wound is not pleasant in any way. From the noise of the machine 24/7, to the stress of looking at my exposed tendons, to me not being able to even bathe properly, this was in no means something me or the Dr opted for. It was an absolute necessity and I have all the communications and photos to prove my case.
I really do not want to take you on over this but please do not think I will take this sitting down after everything I have been through. From the 18th of May, it was only last week that I was able to do everyday "normal" things so it has been a very long, painful journey. I do not want to add more drama to the biggest challenge of my life but do not think I will not use every resource I have to take this on. I have a decent enough social media following to make a dent in your reputation, a lawyer in my corner & I have all the evidence that we followed the rules set out by Discovery and this is just a wide stroked response to decline 2 claims that were very necessary and a little research would have proven that to you.
Please let me know the way forward at the soonest.
Regards, Mr Jimmy ***
I am writing to the Ombudsman as we speak. I will fight you to the bitter end on this matter.
Also, please tell someone to contact me via email to downgrade my current policy. Why should I pay you when you have no interest in honouring your end?
I am writing to the Ombudsman as we speak. I will fight you to the bitter end on this matter.
Also, please tell someone to contact me via email to downgrade my current policy. Why should I pay you when you have no interest in honouring your end?
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
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
And then a survey about your service.. what service exactly are your talking about? The really really bad one that doesn't exist?
I bet you the next email will be say you've closed the tickets. Cause that's exactly what you have been doing for the past few months, on repeat
And then a survey about your service.. what service exactly are your talking about? The really really bad one that doesn't exist?
I bet you the next email will be say you've closed the tickets. Cause that's exactly what you have been doing for the past few months, on repeat
It truly fails me to try understand the train of thought here when I discovered my ankle had an infection on a Wednesday evening, had the Dr immediately state I would need wound care treatment on the Thursday and the Friday and he operated on the Saturday. Where the fff do we fit in 30 days Advanced Treatment when the Dr's decision from the get go was to say we would need Negative Pressure Wound Therapy (NPWT) done to prevent me losing function and mobility due to my tendons been exposed. So my Dr was wrong or you trying to find a loophole. Currently my foot is perfect, thanks to the decisions my Dr made. If we had to wait for the 30 days treatment, the end result would have ended very differently. So, in other words, you have no interest in my health, my recovery, just about the bills you want avoid paying.
How embarrassing. The nurse that came out to assist me told me Discovery changed policies ever since they decided they want to open a bank and funnel all monies they can into this. If Discovery cared anything for patients on their medical aid scheme, they would not have changed policies that adversely effect their paying customers. Again, I had this policy for over a decade, does loyalty mean nothing anymore? Does one's health mean nothing? Profits overs the lives of those paying you those profits.
I will fight this via the Ombudsman. Thanks for exposing yourself to me and the rest of the world. I will make sure I spread this as wide as possible. As a warning to those customers thinking their hospital trips and Dr visits are going to be paid as expected.
It truly fails me to try understand the train of thought here when I discovered my ankle had an infection on a Wednesday evening, had the Dr immediately state I would need wound care treatment on the Thursday and the Friday and he operated on the Saturday. Where the fff do we fit in 30 days Advanced Treatment when the Dr's decision from the get go was to say we would need Negative Pressure Wound Therapy (NPWT) done to prevent me losing function and mobility due to my tendons been exposed. So my Dr was wrong or you trying to find a loophole. Currently my foot is perfect, thanks to the decisions my Dr made. If we had to wait for the 30 days treatment, the end result would have ended very differently. So, in other words, you have no interest in my health, my recovery, just about the bills you want avoid paying.
How embarrassing. The nurse that came out to assist me told me Discovery changed policies ever since they decided they want to open a bank and funnel all monies they can into this. If Discovery cared anything for patients on their medical aid scheme, they would not have changed policies that adversely effect their paying customers. Again, I had this policy for over a decade, does loyalty mean nothing anymore? Does one's health mean nothing? Profits overs the lives of those paying you those profits.
I will fight this via the Ombudsman. Thanks for exposing yourself to me and the rest of the world. I will make sure I spread this as wide as possible. As a warning to those customers thinking their hospital trips and Dr visits are going to be paid as expected.