RG
Roderick G

1 reviews | Active since Jun 2014

25 Feb 2015, 09:58

INSECT IN MY EAR, SORRY YOU'RE NOT FULLY COVERED

On Monday the 09th February 2015 in the early hours of the morning, to be exact 02h10, I was woken up from my sleep with an insect burrowing it's way into my right ear, needless to say I didn't want to try and remove it myself out of fear of pushing it further in, I rushed myself to Netcare Mulbarton to have it removed, it was very disorientating trying to drive my car the 6 km with this god awful sensation in my ear, I could have had an accident on the way there,needless to say it was removed safely, the absolute laughable part is that the bill came to R140-85. Discovery Health refuses to pay the amount in full although I have R15 892-24 in my MSA account, I am only covered for them to pay R40.85 and I will have to fork out the balance of a R100-00 below is Discovery's response on the claim:<br> We have not paid the amount on this line as this healthcare service is not covered on your health plan. Please pay the full amount to the provider, It is for this reason that I will be terminating my services with you from the 01st March 2015, congratulations Discovery you lost a client that religiously pays his premium on time every month, that equates to R25 572 per annum over a measly R100

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Replies (1)
Discovery Health
Discovery Health's reply25 Feb 2015, 15:41
Official
Hello Rod3570,

Thank you for your comment.

I investigated your query and confirmed that the claim you are referring to was processed according to your chosen plan type and the Scheme rules. The amount not covered by the Scheme is not a covered benefit and for this reason cannot be claimed from your Medical Savings Account (MSA). I am sorry that I could not offer you a different outcome on your query.

I am glad to hear that you are doing well. You are welcome to contact us should you require any further assistance.

Kind regards
Rishana