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Justin S

1 reviews | Active since Sept 2015

10 Mar 2020, 14:49

Dont want to pay claims

I am currently on Discovery Smart plan which I have been for a number of years. My plan states that it covers the below:

Cover for sports-related injuries: basic X-rays, two specialist visits and a total of four visits to either a physiothe******, biokineticist or chiropractor when referred by a Smart Network GP. You will have to pay R110 for each visit.

I needed to go to the Chiropractor which I followed the correct process by getting a reference letter from my smart network doctor. I then followed by calling Discovery on which Chiropractor to use and they said that there are none in my area with the Discovery smart network and I can go to anyone and claim back.

I went to the Chiropractor on 20 February which was R550 and had to go for follow up on 24 February which was R450. This means that I need to pay R110 per session which means I pay R220 and claim back R780.

They then came back saying that the ICD-10 code is incorrect I then requested my Chiropractor to amend the invoice to the code that's specified on smart doctors reference number. My Chiropractor did this and sent to claim adjustments, three days later I get told that claim was not successful cause of both codes are not on the ICD-10 then ask Chiropractor to amend the invoice again with both codes and behold three days later get to my claim is not successful.

This claiming process is utter ******* and Discovery do not pay claims even after following all there processes. Discovery does not promise on there services.

0
Replies (2)
Discovery Health
Discovery Health's reply10 Mar 2020, 17:02
Official
 
Dear  Justin 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 
Discovery Health
Discovery Health's reply11 Mar 2020, 14:52
Official
Dear Justin S 

We have been in touch with you to answer your comments. 

Regards
Discovery Health Servicing Team