ML
Mikhail L

1 reviews | Active since Feb 2012

22 Jan 2021, 11:41

Months to resolve a simple issue?

I was admitted to Melomed Clinic in Claremont on the 19th of May 2020. My authorization was for 3 days but I ended up staying 14 days at the recommendation of my psychologist and psychiatrist.

I was discharged on the 2nd June 2020 at 18:00. A few weeks later I receive an SMS from Melomed that I need to pay R27000 due to me staying those extra 11 days without authorization. I took this up with the clinic and my doctor who sent through the necessary paperwork to Discovery so that the dates could be updated and the claim reprocessed.

It is now the 22nd of February 2021. After multiple calls to your call center to get this resolved, I am not sitting with a bill of R38000 which is the adjustment that was made. Every single time that I have called in, I was told that this would get resolved and that I do not have to pay anything as I did have benefits available.

In my last call to the call center, I was told that the issue is with your system as it keeps rejecting my claim. How is it that months later this "System Issue" has not been resolved and that my claim has not been updated?

I was admitted to the "Mental Clinic" to deal with my depression and my anxiety, so please tell me what you think all this has done to my mental state these past few months?

Below you will find the names, reference numbers, and dates of the calls I made. These exclude all the calls that Melomed has made.

11 august first call Brian Humphries ***

Nomfundo nkumanda 28 october ***

Nomthandazo fonamzi 11 nov ***

11:09 reprocess Rejection 3 working days mon Tuesday

Montobeko Tphoba *** 14 Jan 2021 Call me back in 3 days (I was called back by Montobeko Tphoba< she was the only agent that followed up with me)

I was told I would receive another update Thursday 21st but did not receive any calls. I would like a callback today from management. I would like this issue resolved today!

Also, why is it that I as a client, have to call in to do follow-ups, is this not the job of your agents?

0
Replies (3)
Discovery Health
Discovery Health's reply22 Jan 2021, 12:44
Official
Dear Mikhail
 
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 
 
Regards 
Discovery Health Servicing Team 
Discovery Health
Discovery Health's reply25 Jan 2021, 14:54
Official
Dear Mikhail
 
We have contacted you and addressed your concern. 
 
Regards 
Discovery Health Servicing Team 
ML
Mikhail L's update01 Feb 2021, 11:38
Reviewer Update
This has not been resolved. I was contacted and told that the issue would be resolved by Thursday 28th Jan...

I have now received another claim update and the dates are still wrong on that claim and there is now a balance of R1748.30 that I need to pay.

I am now seriously ****ing ****ed off at you people and your inability to resolve a simple ****ing issue!!! How many more months am I going to have to deal with this ****?????

I want a call back before the end of this day to have this resolved!!!!