MB
Mariza B

1 reviews | Active since Nov 2016

28 Nov 2016, 07:41

Illiterate?

<p>Referring to application for Out-of-hospital Prescribed Minimum Benefit - Numerous calls were made to Discovery to enquire about this application. Promise of Supervisor that will call me back - I'm still waiting for this call. Mail was sent to Prescribed Minimum Benefit department explaining issues that I had with the letter, dated 21 November, they sent me -</p> <p>1. Treatment dates on the letter that they sent me was wrong</p> <p>2. Will only cover 1 x-ray and 1 specialist visit for my son's broken arm</p> <p>3. No mention of the arm brace and sling that was app**** for as well (without this, broken arm will stay broken!)</p> <p>After enquiring with Discovery Health again, I was told you can only contact the PMB department via mail, no telephone number is available. Since they don't read their mails, there is no way to contact them.</p> <p>This mail was sent to Discovery 3 times, requesting that they contact me. Their response - The same original letter that they sent me, just with a changed date on.</p> <p>None of the mentioned issues were addressed.</p> <p>Really, I pay R72 000 annually for medical aid, have R18 000 in savings (day to day) and Discovery can only cover 1 x-ray and 1 doctor's visit on PMB cover? Cover for the arm brace and sling? No hospital claims for the last 8 years and still Discovery can't pay R4 100 for an arm brace and sling?</p> <p>My son didn't plan to break his arm, surely this must be seen as an emergency and must be covered, as specified in the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:</p> <p> A defined list of 270 diagnoses (PMB code 902H)</p> <p>I am so disappointed and frustrated. Discovery PMB department please read your mails and correspond in an appropriate matter.</p> <p> </p> <p> </p>

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Replies (7)
MB
Mariza B's update29 Nov 2016, 06:10
Reviewer Update

Guess what? I received the exact same letter (with a new date on) yesterday for the 4th time now. Clearly they still can't read.

Discovery Health
Discovery Health's reply29 Nov 2016, 08:12
Official

Dear marbeukman72

We’re sorry to hear you’re dissatisfied. Please give us a chance to look into your query and we’ll be in touch soon.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply01 Dec 2016, 10:54
Official

Dear Marbeukman72

We’ve just sent you final feedback by email. Please contact us if you have any other queries.

Regards
Umiksha Maharaj

MB
Mariza B's update12 Dec 2016, 06:16
Reviewer Update

Guess what? After approving the arm brace and sling, now Discovery has rejected the claim for a second time around. After phoning Discovery Health, the lady verified that the codes and all other info were correct with the claim and she don't know why it was rejected and I must contact the PMB department.

Discovery PMB department - The motivation letter you requested for the x-rays was sent to you last week - please act on this soonest.

How much more can one take?

MB
Mariza B's update19 Dec 2016, 11:46
Reviewer Update

The arm brace will now be paid on the 21st of December. Thank you.

Discovery PMB department - 2 mails (the motivation letter and the previous x-ray reports) were sent to you already.

PLEASE action this request with a matter of URGENCY.

Discovery Health
Discovery Health's reply20 Dec 2016, 14:09
Official

Dear Marbeukman72

We have been in touch with you to answer your comments. Please contact us if you have any other concerns.

Regards
Cornelius

MB
Mariza B's update20 Dec 2016, 14:12
Reviewer Update

Thank you very much Discovery.

All has been sorted for now.