ZM
Zainab M
1 reviews | Active since Jul 2014
18 Feb 2015, 11:06
Medical aid did not cover hospital care
On the 3rd of December 2014 discovery did not pay out a claim lodged by Dr. S.A. Camroodien. I received an email to say that I did not have enough funds in my medical savings account, however, this claim was lodged by the hospital as I was admitted there. On the discovery website it states that Discovery will pay 100% cover on coastal saver plans if you have been hospitalised. As I am on this plan I was quite upset that the medical aid did not pay out.
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Discovery Health's replyOfficial
19 Feb 2015, 10:16Hello zainabmowzer,
Thank you for your comment.
As discussed, outside of the legislated Prescribed Minimum Benefit (PMB), schemes are entitled to decide which tests and procedures it funds and from which benefit. When you seek medical treatment at a casualty unit at a hospital and the treating provider deems you well enough to go home, your claims will be paid from your available day to day benefits.
I have investigated the possibility of these claims being linked to PMB's however, found that the diagnosis is not linked.
I discussed the details of the claim being funded from your available Medical Savings Account (MSA).
Kind regards
Rishana
Thank you for your comment.
As discussed, outside of the legislated Prescribed Minimum Benefit (PMB), schemes are entitled to decide which tests and procedures it funds and from which benefit. When you seek medical treatment at a casualty unit at a hospital and the treating provider deems you well enough to go home, your claims will be paid from your available day to day benefits.
I have investigated the possibility of these claims being linked to PMB's however, found that the diagnosis is not linked.
I discussed the details of the claim being funded from your available Medical Savings Account (MSA).
Kind regards
Rishana
Discovery Health's reply19 Feb 2015, 10:16
Official
Hello zainabmowzer,
Thank you for your comment.
As discussed, outside of the legislated Prescribed Minimum Benefit (PMB), schemes are entitled to decide which tests and procedures it funds and from which benefit. When you seek medical treatment at a casualty unit at a hospital and the treating provider deems you well enough to go home, your claims will be paid from your available day to day benefits.
I have investigated the possibility of these claims being linked to PMB's however, found that the diagnosis is not linked.
I discussed the details of the claim being funded from your available Medical Savings Account (MSA).
Kind regards
Rishana
Thank you for your comment.
As discussed, outside of the legislated Prescribed Minimum Benefit (PMB), schemes are entitled to decide which tests and procedures it funds and from which benefit. When you seek medical treatment at a casualty unit at a hospital and the treating provider deems you well enough to go home, your claims will be paid from your available day to day benefits.
I have investigated the possibility of these claims being linked to PMB's however, found that the diagnosis is not linked.
I discussed the details of the claim being funded from your available Medical Savings Account (MSA).
Kind regards
Rishana