1 reviews | Active since Sept 2015
Misinformation in contract + no refund for costs
I am on a essential delta saver plan. On the 23/09 I had a severe allergic reaction and had to be rushed to casualty as my throat was closing. Today I receive a bill for R826 for casualty fees. No where in the discovery health documentation does it stipulate that one has to pay additional fees when admitted to casualty ward. Under Hospital Cover (in the saver series document) it clearly states \This is the cover you get when you are admitted to hospital for emergency and planned hospital admissions'. I would constitute ones throat closing as an emergency. After speaking to consultants for 2 hours I am told that this expense comes out of my savings and not my hospital cover & that I will not be refunded for this cost even though there is not a single word in the documentation (in either two documents: saver series + financial advisor) that categorically stipulates that I have to pay additional fees for being admitted into casualty. How can I be expected to pay this amount if discovery documentation makes absolutely no mention of casualty being constituted as a day 2 day savings deduction & when it states that hospital cover includes emergency? Disgusted. Savings account is now zero"
Thank you for your comment.
I investigated your query and understand you are unhappy with the funding decision app**** on your claims incurred on 23/09/2015 whilst seen at the emergency facility.
I note that these claims were funded from your available Medical Savings Account (MSA). As there was limited funds in your MSA, a portion of the hospital account remained unpaid.
As per the Scheme and your plan benefit Rules, any claims resulting from a casualty visit will be funded from your available MSA or your own pocket. If you are admitted into hospital after visiting casualty and your admission has been approved, the casualty account will be paid from the Hospital Benefit. I understand you were not directly admitted into hospital following this casualty treatment.
We are able to review your claims as an emergency provided we receive further clinical information to establish whether this constitutes as an emergency. I sent you an email with further information and the options available to you.
Kind regards
Bruce
Thank you for your comment.
I investigated your query and understand you are unhappy with the funding decision app**** on your claims incurred on 23/09/2015 whilst seen at the emergency facility.
I note that these claims were funded from your available Medical Savings Account (MSA). As there was limited funds in your MSA, a portion of the hospital account remained unpaid.
As per the Scheme and your plan benefit Rules, any claims resulting from a casualty visit will be funded from your available MSA or your own pocket. If you are admitted into hospital after visiting casualty and your admission has been approved, the casualty account will be paid from the Hospital Benefit. I understand you were not directly admitted into hospital following this casualty treatment.
We are able to review your claims as an emergency provided we receive further clinical information to establish whether this constitutes as an emergency. I sent you an email with further information and the options available to you.
Kind regards
Bruce