TB
Talitha B

1 reviews | Active since Feb 2024

05 Mar 2024, 11:20

Lack of feedback and therefore complaining is useless!

I am making an entirely new complaint because the honestly deserve it. I already posted my claim in February. I called them numerous times. I emailed them (attached in the previous review). I changed the claim like the operator in the chronic department stated to do (explained in the previous review). I received this email today after more than a month stating the same old excuse and requesting me to change an old claim I already paid out of my pocket. I can't afford to have a bad credit rate. I can barely afford a medical aid as I am a student. I cannot change the claim now due to your mistake and a lack of feedback

Not even complaining on Hello Peter changes anything as they take too long and have million excuses and reasons when it comes to paying.

Please refer to my previous review as well for more information.

0
Replies (4)
TB
Talitha B's update05 Mar 2024, 11:24
Reviewer Update
Please see below quoted review:
"28 Feb 2024 at 10:18
Misinformed on chronic benefits and making up excuses not to pay
I have spoken to a few operators, especially in the chronic department. I would like to formally complain about Discovery not paying Capitol Radiology for a swallow test done on 09/02/2024: I sent an online query to Discovery explaining that last year my nominated GP send in the application form to go see rheumatologist, Dr. Joyce Ziki. It was declined and I pay her cash since last year; September 2022. She did the right tests and app**** for the chronic condition: arthritis and uses a ICD-10 code of M06.99 on any test requested. The problem is I did the swallow test on 09/02/2024 and on the physical form the chronic ICD-10 code, M06.99 was written down after I paid cash to see Dr. Joyce Ziki. The claim was not paid due to Capitol Radiology using a chronic ICD-10 code R 13 out of own judgement. I called Discovery and a operator at the chronic department instructed me to request Capitol Radiology to change the chronic ICD-10 code to M06.90 on the 15th of February 2024. She was well aware and told Dr. Joyce Ziki wrote the chronic ICD-10 code M06.99 on the physical paper requesting the test. Capitol Radiology sent the claim through again with the given ICD-10 code; M06.90. The claim was not paid again due to the following reason: "338: We have not paid this amount because this claim because you have not followed the specialist referral process on you. Please pay this amount to your specialist." I talked to two operators today, 28/02/2024, and especially to Bongolethu in the chronic department. She explained to me on the chat platform that the code should have been M06.99 and not M06.99. She said that the chronic benefits for arthritis does not cover the swallow test. My question is how does no one give me this information since enquiring online (Website query) ; calling the chronic department on the 15th of February 2024 and now talking to the operators through the chat bot application. I do not see the justification in paying Capitol Radiology under the reference due to reason 338. I did not see a specialist. My rheumatologist, treating me for arthritis, requested the quest using the ICD-10 code M06.99 to further her treatment. I suggest give me the real reason for not paying Capitol Radiology for the swallow test with the given ICD-10 code M06.99 OR I will be looking for a new medical aid immediately!"


TB
Talitha B's update05 Mar 2024, 11:25
Reviewer Update
Update on review:
"05 Mar 2024 at 11:14
Yesterda afternoon a woman called and hung up because she doesn't handle key care. Heard nothing until today. Iam currently working and missed a call from Anika Botha. I received an e-mail stating the reason for cancelation that I already received. I got the instruction to request the claim should be CHANGED AGAIN and then MAYBE they'll pay. The code should be changed to the code that was given originally by my rheumatologist. Which the first operator received and then gave me the claimed quote that was sent through. I had to pay the account already as it has been a month already and Capitol Radiology wants money. I am sitting in an unfortunate financial position but yet my debit orders still went off. I am barely surviving and receiving the wrong information from the chronic department left me in an unfortunate spot. I can't change the claim. I had to pay. I sent emails and called the whole of last month and this solution was only given after more than a month! This is why I will be updating this complaint once more."
Discovery Health
Discovery Health's reply05 Mar 2024, 12:04
Official
Dear Talitha B

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 

Regards 
Discovery Health Servicing Team
Discovery Health
Discovery Health's reply14 Mar 2024, 11:52
Official
Dear Talitha B

Please check your emails for feedback from us.

Regards

Discovery Health Servicing Team