Know your rights when medical claims are mismanaged.

When your benefits are mismanaged and handled by inexperienced staff not having insight and understanding of plan benefits you must follow the procedure and rights as a paying member as follows.

Capture yoir assigned treatment basket and allowed benefits from your online health portfolio as assigned under your profile. Send to the Principal Officer and keep a copy of this documented. Then do a police affidavit stating the discrepancy on your medical aid. Complete the Council of Medical Schemes complaint form and attach all the documentation. You also have access to the Ombudsman.

Because Discovery is negligent in adhere to paying our according to your plan benefits and as copied on your online profile, you now claim back the monthly payment premiums due to paying monthly premium for benefits that is not granted or available as indicated on your plan and personal online profile.

You have a legal right as Discovery is in violation of, and in breach of contract or a violation of Section 29(1)(c) of the Medical Schemes Act (MSA).

In addition the employee of Discovery who handles the claims are also accountable as such.

Your membership with a medical scheme is a contract where the scheme agrees to provide certain benefits in exchange for your premiums. If they fail to provide those benefits due to their staff's negligence, it can be considered a breach of that contract.

These are basic right we have as paying members and are also protected in addition by the consumer rights law.