AV
Anneke V

1 reviews | Active since Nov 2018

07 Nov 2018, 09:37

Having to sacrifice precious time with my newborn baby to get Discovery to pay out maternity benefit they promised

I have a Discovery Coastal Core plan, which includes a list a of pre and post maternity benefits.

After having a premature baby, I had problems with breast feeding. I saw a lactation consultant and had a post-natal visit with a nurse.

On the Discovery website they list both these services as part of my maternity benefits. On my benefits tracker they indicate that I have not used either of these benefits.

Yet, it seems impossible to submit a successful claim for either service. I have submitted the claims 3 times. I have made about 5 phone calls, lasting 20-30min each to Discovery. Each time they confirm that my benefits are still unused, but claim that my nurse are using the wrong ICD10 codes. My nurse have made about 5 phone calls to Discovery, also lasting 20-30min each. Every time Discovery admits that I have a legitimate claim. Twice they told her that their agents captured the wrong code on her invoice (they captured the tariff code instead of the ICD10 code). During the last call they told her that the only ICD10 code she is allowed to use is for a post-natal visit after I have been discharged early. They told her that the ICD10 codes for lactation consults are not loaded on Discovery's side and can therefore not be used by her.

Now I want to know with tears in my deep blue eyes!!!!!! If Discovery don't acknowledge the codes ICD Code O92.1 to O92. 7 (appropriate for lactation consults), how on earth am I supposed to claim for using this benefit?

This dispute has been going on for months now. I have spent so much money phoning Discovery and holding on forever to be connected to call center agents who cannot help me. I have been promised by call center managers that they are escalating this matter and told that they will sort it out. Yet, here I am, months later and no resolution.

Terrible terrible service indeed!

0
Replies (2)
Discovery Health
Discovery Health's reply08 Nov 2018, 10:31
Official
 
Dear *** 

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 reply12 Nov 2018, 14:45
Official
 
Dear *** 

We have been in touch with you to answer your comments.
 
Regards
Discovery Health Servicing Team