Hospital Claims - Doctors

<p>I was in hospital during 23 to 26 December 2016 for c-section. Now I am experiencing problems with my Doctors Claims.</p> <p> </p> <p>Discovery is not paying the gynae and the peadiatrician due to the code:</p> <p>6 = Your Plan excludes cover for this claim - we have not paid it.</p> <p> </p> <p>My plan Essential Delta Saver provides payment for specialist as stated in the booklet that was sent to us!</p> <p>AS FROM THE BROSCHURE/BOOKLET:</p> <p>Related accounts<br />Specialists we have a payment arrangement with = Full cover<br />Specialists we don’t have a payment arrangement with and other healthcare professionals = Essential and Coastal | 100% of the DHR</p> <p>Both these Doctors in questionare network doctors Discovery has apayment arrangement with.</p> <p> </p> <p>I called you guys on 5 January 2017 to get this sorted at first I only had the account for the peadiatrician and Ampath that you also did not want to pay as my plan apparently also doesn't pay for radiololody/pathology tests but it clearly stated it did. I spoke to Shiyaam Pauls and she said she will resend these accounts for me and she called me back on 9 Janaury 2017 informing me that you re reprocessing these accounts and they will be paid from my hospital benefit. To date only the pathology test for Juandice was paid, after I had to have a fight with you guys as you only pay certain pathology test and this was not one of them but no were is there written only certain tests, and a Juandice test for a newborn is of the utmost impotance as the illness can cause permanent damage to the infant ( Permanent damage may lead to cerebral palsy, deafness, and intellectual impairment).</p> <p> </p> <p>I sent you guys an email regarding both the Doctors claims on 10 Janaury 2017 to date you guys have not called me back or sent an email with explanantions. Also the doctors are not being paid making it diffilcult for me as I need to go see them again and your brochure clearly states you will pay the related accounts for my hospital plan.</p> <p> </p> <p>This is really unacceptable! As we have to pay you each month for a service we are clearly not receiving!!</p> <p> </p> <p>You can check all my references:</p> <p>Standard inbound call - Consultant SHIYAAM - Reference number ********** 169</p> <p>Refenrences Shiyaam gave me that day: 48****9578 and ********** 872</p> <p> </p> <p>Email I sent your portal: Mail REf: ********** 495 and my reference for Email: ********** 943</p> <p> </p> <p>If you go and read my email and actually make work of this you will see that I included screenshots of your brochure as speaking to a consultant makes it clear that Discovery is an ************* business if you can call them a business as the only thing they are doing is lieing to their members!</p> <p> </p> <p>I want this accounts paid and sorted immediately as you guys have NO reason to not pay the accounts!!!!!</p> <p>I had a valid Authorization number for the procedure and the Gynae in question!! You are more than welcome to go look up my reference as you continuosly sent me the Auth even after the procedure was done!</p> <p> </p> <p>You guys want payment each month but you are not willing to keep your part of the contract to pay the service providers as needed.</p> <p> </p>