kP
kelly P
1 reviews | Active since Sept 2015
10 Sept 2015, 16:11
INCORRECT BILLING, NOW I AM UNABLE TO SEE A DOCTOR AND IT IS AN EMERGENCY. INSTEAD I NEED TO PAY CASH!!!!!
I was admitted to hospital in may and in September I needed to go to GP. only to find out my medical savings has been depleted. I have unlimited hospital benefits but discovery used up all my day to day medical savings instead. I need to urgently see a Gynecologist and now due to discovery using my savings I needed to pay cash. This is unfair. why do I pay R2000 a month for medical aid if I cannot make use of it when I need it the most!!!!!!
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Discovery Health's replyOfficial
14 Sept 2015, 10:30Hello KellyPentolfe,
Thank you for your comment.
We confirmed that the claims for your hospital admission in May 2015 have been reprocessed to pay from the Hospital Benefit. The funds that was used from your day to day benefit has been returned. We process claims based on the information that we receive. Should the details on the claim differ from the information on the authorisation, the claim might either reject completely or pay from your day to day benefits as it will not link to the authorisation. The hospital sends us periodic updates so that we can update the information of your hospital admission. At the time when the claims were sent through, the necessary updates were not received which lead to the claims being processed incorrectly.
On your plan type you have access to the Insured Network Benefit which covers you for GP consultations once your savings have been depleted. The doctor needs to be on our network and has to charge specific consultation codes in order for us to cover these claims. You have access to an additional three consultations once your savings have been depleted.
Please do not hesitate to contact us should you require any further assistance.
Regards
Annelize
Thank you for your comment.
We confirmed that the claims for your hospital admission in May 2015 have been reprocessed to pay from the Hospital Benefit. The funds that was used from your day to day benefit has been returned. We process claims based on the information that we receive. Should the details on the claim differ from the information on the authorisation, the claim might either reject completely or pay from your day to day benefits as it will not link to the authorisation. The hospital sends us periodic updates so that we can update the information of your hospital admission. At the time when the claims were sent through, the necessary updates were not received which lead to the claims being processed incorrectly.
On your plan type you have access to the Insured Network Benefit which covers you for GP consultations once your savings have been depleted. The doctor needs to be on our network and has to charge specific consultation codes in order for us to cover these claims. You have access to an additional three consultations once your savings have been depleted.
Please do not hesitate to contact us should you require any further assistance.
Regards
Annelize
Discovery Health's reply14 Sept 2015, 10:30
Official
Hello KellyPentolfe,
Thank you for your comment.
We confirmed that the claims for your hospital admission in May 2015 have been reprocessed to pay from the Hospital Benefit. The funds that was used from your day to day benefit has been returned. We process claims based on the information that we receive. Should the details on the claim differ from the information on the authorisation, the claim might either reject completely or pay from your day to day benefits as it will not link to the authorisation. The hospital sends us periodic updates so that we can update the information of your hospital admission. At the time when the claims were sent through, the necessary updates were not received which lead to the claims being processed incorrectly.
On your plan type you have access to the Insured Network Benefit which covers you for GP consultations once your savings have been depleted. The doctor needs to be on our network and has to charge specific consultation codes in order for us to cover these claims. You have access to an additional three consultations once your savings have been depleted.
Please do not hesitate to contact us should you require any further assistance.
Regards
Annelize
Thank you for your comment.
We confirmed that the claims for your hospital admission in May 2015 have been reprocessed to pay from the Hospital Benefit. The funds that was used from your day to day benefit has been returned. We process claims based on the information that we receive. Should the details on the claim differ from the information on the authorisation, the claim might either reject completely or pay from your day to day benefits as it will not link to the authorisation. The hospital sends us periodic updates so that we can update the information of your hospital admission. At the time when the claims were sent through, the necessary updates were not received which lead to the claims being processed incorrectly.
On your plan type you have access to the Insured Network Benefit which covers you for GP consultations once your savings have been depleted. The doctor needs to be on our network and has to charge specific consultation codes in order for us to cover these claims. You have access to an additional three consultations once your savings have been depleted.
Please do not hesitate to contact us should you require any further assistance.
Regards
Annelize