Maternity Benefits compensated out of Medical Savings Account

Dear Readers (and Discovery), 1. I have been called back at 12:20pm this afternoon by 'Mohammed' from Discovery after my advice that they should call me and not reply via email. Kuddos. The issue has therefore been escalated with (it seems) a positive response, pending an outcome which I will receive in 2-3 Working days/or advised on Friday the 27th. So I will revert back with an update as soon as the above period has lapsed. 2. Comprehensive Maternity Benefit (Serious issue - Please read if you are an expecting Mom/Dad etc., or wanting to fall pregnant): One issue that is still very relevant is that advice from the discovery website rings as follows: "once your are 12 weeks pregnant you can contact us on ***to authorise your admission". This (without stating it clearly) states that you dont need to indicate your pregnancy up until such a date/progress in time during your pregnancy. So we (My wife and I) did exactly that. Now that I want to claim benefits used against the Comprehensive Maternity Benefit for visits to the Midwifes Exclusive in the first 12 weeks period, Discovery advises these claims as invalid as we have not activated our benefit. Instead, our benefit is for the period of 2018/02/02 -2018/08/15...only 7 Months. Now it begs the question, why would the Comprehensive Maternity Benefits after having been activated not be valid for a normal gestation period of 40 weeks, i.e. about 9.21months (to be exact). My opinion is that the Maternity Benefit Period must be 'backdated' to the gestation date/inception, as now suddenly my wifes first 3 months of pregnancy is not 'registered' based on the above advise and now my claim is invalid for that period. Worse case scenario is that everything that could have gone wrong did go wrong in the first 3 months, then we would not have been covered. In summary, (for the readers), please activate your benefit as soon as you fall pregnant. This 'seems' obvious, but after I read on their website, did I only follow the 3 Months/12 weeks 'advise'. (For Discovery) Dear discovery, please attend to this matter and provide me with a reasonable assessment based on all the above information. I look forward to a positive outcome. Best regards,

Dear Discovery and Readers, I have received correspondence indicating the 'willingness to assist me' in an 'expedient way' and 'we are trying everything on our side' kind of answer. I appreciate the feedback in that regard. However the "answer your comments" reply that is referred to has in no way been answered yet (this meaning I have had 0% information on the factual outcome so far., i.e. Discovery are looking into it, OR they are trying their best OR...etc and so forth). I kindly ask Discovery to not portray the above in a way that makes it seem as if 'the matter has been resolved'. It is a wrongful depiction of where we are at in this discussion. In short, the matter still stands at 2-3 days before it still 'will be addressed' and a clear resolution is not yet on the table - as I've stated, the willingness to hear me out has been indicated. It stops there at this point in time. Thank you. Best regards,

Dear Readers, So today is the 30th, but we still do not have a final resolution yet, in fact we are still at a 0% outcome based on all the above. The midwifes have now forwarded new Claims with amended ICD-10 codes etc., and we are then now awaiting further feedback as once again, the amended claims have been send and I have received a reply from another agent from Discovery, which makes me think that the follow-up process has now been lost in the wind. I would have liked Mohammed and Brendan to perhaps follow-up, but perhaps this is still in the making. Awaiting their final feedback still as this has now become an administrative procedure once again and not something of clear resolution being driven by Discovery to a final solution. Best regards,

Dear Readers, I haven't been able to write in a long time as our child was born in the interim of all the above. It has been an interesting period where I have not really received the full benefit of my Discovery Health Medical Aid. It is a shock to me that the impressions created over the telephone and with the pre-assesments and evaluations beforehand and the outcomes afterwards all definitely lean in favour of Discovery Health and just ensures that I as a client am unhappy (More like grievously dissapointed) with the service provided. To get back to the above process - it has come to some sort of conclusion. I'm going to summarize it: 1. Claims paid from my savings account where reversed and paid out of our "Comprehensive" Maternity Benefit. Do note that the limit amounts paid out where now lower (as this comes out of Discoverys pocket, but fortunately my Savings account was increased with the amount deducted out of my Savings previously with the pay-outs). 2. Unfortunately, due to the limits now being lower, there was a problem in that there is now a shortfall due to the previously paid out amount with the 'higher' limit under the first claim came out of the savings account into my bank account and thus, to top up my Savings Account again, I now owe the Scheme. This was and still is not clearly communicated over the phone, however when I go into my new claims subsequent to the above, I can now notice how they recoup those monies by not paying me out the Cash into my bank account, but now indicating that I still owe the Scheme and thus reducing the amount owed against the new claims by not paying them out...clever ne. 3. Unfortunately it seems that there is another way they have now blocked me to access the site in that I cannot go into the claims breakdown from their online portal to check where the claims are paid from etc. I hope it is something they will rectify. I do feel that my rights are becoming more limited by the way they act on our "very romantic history of claims". Birthing process: At the day of my wifes hospital admission at 4h30 in the morning at Life Wilgers we tried to book in for our birth and be ready before the mad rush of people needing help, so we can be easy settled in with our Midwife guiding us in the process. As we tried to fill in all the blanks it wasn't long that we then noticed that our Preauthorization code has gone missing on Discovery's side. After three discussions with them on the telephone before getting to the hospital and well in advance (two of which reference of the calls are ********** 224 and ********** 787) of our booking in, we still did not have our pre-authorization (which was up until that point ********** 8). Needless to say, I had to organize (thankfully having the time in hand) a new "Pre"-Authorization code to get us through the process save and without any unnecessary hassles afterwards with claims etc. Finally; we also went through the whole birthing process with the Midwifes Exclusive and they have been really awesome. Without them helping, my grievances would have been much worse. The fee for the Midwifes was also given to Discovery early on for a Pre-assesment before birth (Feedback received from Discovery was that about 68% of the amount would be paid out back to us). The plan was to birth at home, but changed to an in-Hospital birthing process. I would reckon as a general rule that fees paid for an in hospital birth will be covered (Depending on your plan) in full (either 100% or 200% or even more). Unfortunately Discovery are indicating that only about 50.79% of this "in-hospital" treatment with an authorization code will be paid out to us for the Midwifes claim - as we needed to pay the amount is Cash before the planned birth at home (Please note the amounts for birthing at home or in hospital differ by about R 100 - this included the Induction that we needed to do, so the Hospital Birth would in fact be less expensive in comparison). Furhter on; there were no other Healthcare professionals needed during the birthing process, so this should "in laymans terms" have been a very "cost effective" birth for Discovery to cover. Dissapointed to say the least and will ensure that this post gets pinned for proper feedback from Discovery and not the standard discussion like the above but a typed out explanation ("We have contacted you with a resolution to your issues - ******* response") on paper. Thank you.