DL
Debbie L

1 reviews | Active since Jun 2016

13 Jun 2016, 18:28

Medical aid would pay the claims

<p>My 78 year old mother was hospitalised on the 4th April 2016 for 2 days she is on Key care Plus A scheme with a 12 month waiting period for blood pressure. Her hospitalisation has nothing to do with her blood pressure. She was admitted to Crompton Hospital casualty - physician saw her test done Discovery 1st aothoirse 1 day then reject it - then authorised 1.5 days reject it need more info from case doctor at Crompton - this gets sent through 5 ****** times to different people it goes to the standards department for review to see if there is any non disclosures they find nothing - it get sent back to the case review department. Again more info requied now. But now I'm really ****ed off a month later and Discovery are still trying to find a loop holet why they should not pay thsee bills. Now in May. All the stuff is sent through again . The MRI report. Pathology reports, ex rays, treatment plan, Dr motivation - back to the standards department for another delay in a decision to pay. In the mean time Discovery are quite happy to accept the monthly premium along with a late joiner fee that gets paid every month. This is now really a pathetic display from such a big company that advertises health care care for everyone but takes your money and treats you like ****. ---- well still again today I am waiting on yet another 5 days whist the standards department of Discovery Health care take their time and I get demands and Lake Smith and Partners just decide to take a debit order off my bank accout for the debt because of the icompetence of one of the biggest Health care companes. -------- I rest my case oh by the way I was told you can't speak to anyone other than the call centre agent they would not put me through to a manager to lodge my complant. </p>

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Replies (5)
DL
Debbie L's update13 Jun 2016, 18:41
Reviewer Update

It is actually the medical aid would not pay the claim I'm still waiting on a response from them 6 weeks later

Discovery Health
Discovery Health's reply14 Jun 2016, 06:24
Official

Hi Bettybump

Thank you for calling our attention to this issue. We will provide you with feedback as soon as possible.

Regards
Discovery Health Servicing Team

DL
Debbie L's update14 Jun 2016, 07:27
Reviewer Update

Thank you

the waiting period I am full aware of and has nothing to do with the reason as to why my mother was admitted to the hospital .

Discovery Health
Discovery Health's reply15 Jun 2016, 09:42
Official

Dear Bettybump

We have sent you an email directly addressing your concerns. Please check your email and let us know if you have any further queries.

Regards
Sirgree

DL
Debbie L's update15 Jun 2016, 11:11
Reviewer Update

Thank you for the response and aproving the payments.

However due to Discovery not allowing the MRI to take place on the 5th of April 2016. ( mom could only have it done at Westville hospital the next day due to the late rèspone from Discovery) I am now having to pay out R16 800. As a private patient. Where medical aid rate Is R5000. If it was done on the 5th or if Discovery paid it. I also have to ask Crompton Hospital for a discount of fees as I now have to pay the balance of their account too. 1.5 days.

Thanks for your help Discovery The council for medial schemes looks interesting at this stage.