AS
Andre S

1 reviews | Active since Jan 2011

29 May 2023, 17:20

EMERGENCIES ARE NOT COVERED IN FULL AS PER BROCURE MAKES YOU BELIEVE

I was admitted into hospital for an emergency from the ER, I had to pay R1200.00 out pocket for the Doctor fees at the ER and was told that it will be paid back by Discovery if I get admitted, I was admitted. When I submitted the claim to discovery, the full amount was not paid back. I then called Discovery and spoke to Kim Thomas who in turn told that they wont pay back the full amount as its above the agreed rate. I then advised but hospital cover shows as "unlimited" not as per Discovery rate. She then she sent me the Saver Plan Boucher to confirm her statement. On page 7 under heading EMERGENCY COVER it states the following: "We pay for all of the following medical services that you may receive in an emergency: The account from the hospital The accounts from the doctor who admitted you to the hospital. Please refer back to the word ALL and nowhere is it stated as per Discovery rate. Next to that there is a pic of cell phone with the following written "Emergencies are covered in full" This was not the case when i was in the ER. I called back, got greeted with what sounded like an office party going on and the call center agent quickly putting her mic on mute hoping i would hang up. I uttered the words "this call is recorded so you can unmute your mic" and can you believe it she started to talk! Started to make all sorts of excuses on why she did not talk..... She then put me on hold trying to get hold of Kim.... going for 31 mins into the call she advised hung up the call on me.

0
Replies (5)
Discovery Health
Discovery Health's reply30 May 2023, 07:44
Official
Dear Andre V

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
AS
Andre S's update01 Jun 2023, 14:44
Reviewer Update
Shaun Govender called me back from Discovery stating that what us will consider an emergency that a medical person will not concider an emergency, In my non medical capasity, if a doctor admits you into hospital from the ER, something is wrong and you wont be admitted if you are fit to go home. He advised that he will get back to me.
Discovery Health
Discovery Health's reply01 Jun 2023, 15:09
Official
Dear Andre V

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

Regards
Discovery Health Servicing Team

AS
Andre S's update15 Jun 2023, 21:42
Reviewer Update
No, you called to say a medical team will review my query and get back to me. Still no reply from Discovery.
AS
Andre S's update04 Jul 2023, 14:15
Reviewer Update
Still no reply regarding this matter from Discovery.