INCAPABILITY TO RECAPTURE A CLAIM

<p>Being a loyal paying member of Discovery with little to no hospital benefit claims- and mostly claims paid from our MSA (medical savings account- of which the funds are provided by ourselves ) ,One would hope that if you do make a small hospital benefit claim that Discovery would pay for it with out complicatins .</p> <p>My son had a minor procedure booked at dr.s A C L And M E Landman Incorporated on 25 January 2017</p> <p>I obtained the hospital benefit authorization number with the procedure codes as given by the doctors rooms.</p> <p>After the procedures – I only had to submit the claim for the aneathetist as I had to pay him in cash on the day. Having a hospital benefit authorization- that should not have been a problem..however …</p> <p>I discovered that Discovery do as they please.</p> <p>Claim 1 for the doctor and the doctors facility - dr.s A C L And M E Landman Incorporated-</p> <p>Some lines were processed against our MSA and some against hospital benefit – Only after several calls this has been rectified and the R970.88 was credited back to our MSA.</p> <p>Claim 2 for the aneathetist dr Geldenhuys S T L</p> <p> </p> <p>Partial lines were processed against our MSA – for the amount of R683.12 –</p> <p>The full claim amount was for R1170.99 –</p> <p>Discovery only processed some lines- and instead of processing these lines against the hospital</p> <p>Benefit- they processed it against our MSA and refunded us the R683.70 -taking it form our MSA- which was not agreed upon as I did get a hospital authorization.</p> <p>Which needs to be corrected – in other words they need to credit our MSA and charge it to our hospital benefit .</p> <p>Discovery came back saying that the doctors claim needs to have it this way : the Modifiers need to be placed after the procedure codes in order for them to be linked to the correct line on a claim. -as from Discovery on 16 Feb-</p> <p> I requested the change from the Doctor – which he then did and resubmitted the claim. After a period nothing has been done to correct it . After I spoke to Discovery again , and to the Doctors rooms. I was told by the doctors rooms that Discovery admitted ( on a recording-ref ********** 508 ) that they have processed the 2 modifier codes wrongly – and that they were actually correct- so the claim stays the same – I then submitted this info to discovery again – refer my mail dated 2 Feb Attention Tumelo( who was then handling the case) ********** <p>gain time when by and I had to phone again – just to hear again that the codes on the claim was wrong – I then spoke to a Charna – who was going to resolve it all and get the doctor to again change his claim …..The doctor was contacted again – and again nothing happened from discovery’s side</p> <p>I have since spoken to the doctor who is obviously getting quite fed ups as I am – he has been processing he’s claim for the same procedure ( of which he does many ) for the past 7 years. In exactly the same manner and order..even plenty after my sons procedure- And plenty that have also been submitted to Discovery.- WITH NO PROBLEMS LIKE THIS WHY !!!!!!!!!!!</p> <p>I have then contacted Discovery again – now they are saying : We have not paid this claim as your provider used a modifier code not related to any procedure code on the account on line 2 and 5.</p> <p>There was no mention of it being the wrong modifier code before- now all of a sudden it is the wrong code !!!!!!!-(as per their mail MailRef# ********** 114#- dated 11 April 2017)</p> <p>Personally this feels like a vendetta against us now. Why will our claim not be correct but so many others with the exact same have had no problems</p> <p>I think the doctor has done all he needs to- and should clearly not be contacted anymore – and that Discovery will have to go back and recapture the codes in a different sequence – as they want it – seeing as they are the only ones that know how they want it for this particular claim –</p> <p>I have since requested an example from Discovery – I have asked them to show on the claim what needs to be changed .. I have clearly not received that back – only some more reference numbers to add to the other 50 that I already have. Our Msa needs to be credited and we still need the refund from the balance of the claim that we paid to the doctor .- and the full amount needs to be posted to our MSA.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> <br /> <br /> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p>