Members pay your salaries

Thanks, Anil. You are wonderful and I havee no doubt that you can resolve my problem but I will not allow you to take control. It should not be necessary for members to resort to hellopeter to get Discovery to respond but this is what happens every time. Will you be available next time? I have been through this every time for 12+ years and I suggest that Discovery address their problem. I don't care if they never refund me. I will not go through this again. If you expect your members to know all the codes, Discovery must send all members the book of codes and all the rules that your Claims Dept use to reject a claim.

I went back to the surgeon to acquire a revised statement and asked him to ensure that it included every possibly code that Dscovery would need. I do not have the "book of codes"so cannot verify that 0190, S42.40 and W01.09 are correct. I submitted this statement with proof that I had paid the bill on 14 June. On 17 June, the claim is rejected yet again as follows:

Reason code 581: We have not paid the amount on this line as the claim did not include an ICD-10 code. We have asked the service provider to resubmit an amended claim.

On the invoice the ICD-10 code is in the second line and should be on the first and that’s the reason why the claim won’t be processed by our claims assessors. We need amended invoice.

How I am suppoosed to know the codes, which code is the ICD-10 code and which line it should be on? Discovery are doing what they have done for 15 years. They pay any bill submitted from the medical profession without my approval but they find every possible excuse NOT to refund the member. Is this because you can't deduct a 25% admin fee when you refund a member? I usually give up trying to get a refund. This time Discovery must refund me with promise that tthis will not happen again. To achieve this they must either train the people in their Claims Dept or provide all members with a book of codes and rules so we can check that doctor's statement is correct BEFORE we submit the claim. I have done EVERYTHING Discovery told me to do. They never mentioned that the ICD-10 code had to be on the first line. If I get a statement from the surgeon with the ICD-10 code on tthe first line, what will be your nexy excuse for not paying? I am sure that you have many competent people in your Claims Dept but they must adhere to the Discovery Book of Rules. Please send all members the "book of rules" instead of feeding us the rules one at a time. Members cannot live long enough to learn all the rules! The FIRST time you rejected the claim you should have send me the rules regarding a claim submitted by a member. From my personal experience, the rule book says "Find a reason to reject the claim and keep finding reasons until the member gives up trying to claim". I am NOT giving up this time. Please do not think that refunding me this little bill will make the problem go away because I know that next time I submit a claim, I will experience the same problems. Perhaps Discovery Health should focus on Health. My previous complaint on HelloPeter to Discovery was to stop hounding me with all your other investment/insurance opportunities. That complaint worked so I pray that this complaint will be resolved.