No pay and no say from Discovery "help".

I am a Discovery member as well as a service provider and am becoming increasingly dissatisfied and frustrated with their product and their service, particularly the call centre and those that respond to emails sent to the generic addressed.

This complaint focusses on my experience as a member.

I am on the Classic Comprehensive plan (which is an expensive plan) and my son is a dependent on this plan. Having a young child means higher medical costs and I had used my MSA and closed my self-payment gap by the end of April/beginning of May 2018. However, I was ok with this, as I believed that my subsequent claims would now all be paid in full due to my "unlimited" Above Threshold Benefit. I couldn't have been more wrong and have recently come to discover the following home truths: 1) The "unlimited" ATB is not unlimited. I have a family limit for Al**** Health Services of R23 000 per annum. 2) My MSA and self-payment gap both counted towards this limit. 3) This limit therefore began being reached from 01/01/2018. 4) While I have submitted claims to the amount specified by the limit, the amount actually paid to me and the service providers (combined) by Discovery is still approximately R4 000.00 under the limit. 5) I can apply for extended benefit. However, the services my son is receiving from the Occupational The****** are not on the Discovery defined list of acceptable conditions/services and the speech condition for which he is already receiving therapy will need to be diagnosed by either a Psychiatrist/Neurologist/Paediatrician. Therefore, I will now have to pay a medical specialist to diagnose what the speech the****** has already diagnosed. 6) My son would have qualified for the Extended Benefit until 2 years old on the basis that he was born under 2.5kg. Assuming I had known about this benefit and assuming that he wasn't now already older than 2 years.

I emailed Discovery with a list of questions based on the comprehensive statement that I had requested and received (similar questions to the above issues) and the reply I received was for someone to send me the statement on which all my questions were based. It is this kind of lazy and useless "service" that frustrates me the most. If you're not going to pay for something, at least have the decency (and train your staff sufficiently) to address my questions and help me to understand why you are no longer paying. It's one thing if I do not fully understand the ins and outs of the scheme. It is another matter entirely when your own staff do not understand the scheme.