1 reviews | Active since Nov 2014
NOT ACCEPTABLE SERVICE
I obtained an authorization number to have my child admitted to hospital for a tonsilectomy on 17 February 2015. I had to pay R800 for consultation fee and after that R950 THAT IS INDICATED ON THE ACCOUNT AS A CO PAYMENT FOR THE THEATRE.<br> I tried to claim this R950 back as according to Discovery R350 was already refunded into my account - this will have to be still verified as i received no communication in this regard.<br> When i querried the refund of the R950 it was indicated that it can not be paid back , the explanation did not make sense as they indicated i did not use a Keycare specialist. I indicated that their sales representatives that normally come to the workplace indicated that the Specialists are not all willing to be on the Keycare list and one should make use of any specialist and claim the co payment back. My concern is EVERYTHING IN THE THEATRE WAS PAID FOR SO IF THE DR ADDED THIS R950 TO HIS HOSPITAL CLAIM IT COULD HAVE BEEN PAID BUT NOW THAT IT IS CHARGED SEPARATELY SUDDENLY IT IS A PROBLEM. I pay a lot of money every month towards medical and this is how one is rewarded when having to claim.<br> Can someone please let me know if i am going always have this bad service
Thank you for your comment.
I investigated your concerns and can confirm that your provider does not have a payment agreement, which would ensure full cover on your chosen plan type.
This means that the provider is not obliged to charge the Scheme rate for treatment rendered and any cost that is over and above the rates that your plan covers would be your responsibility. The providers are also allowed to charge their patients administration fees which are not covered by the Scheme.
With regards to the consultation fee's, the rate charged by your provider is higher than the Scheme's reimbur*****t rate and therefore you would be responsible for the balance of the account. I emailed you an email with the details.
I understand that this is not the outcome you expected however, I trust this explains the reason for the non-payment of your claim.
Kind regards
Rishana
Thank you for your comment.
I investigated your concerns and can confirm that your provider does not have a payment agreement, which would ensure full cover on your chosen plan type.
This means that the provider is not obliged to charge the Scheme rate for treatment rendered and any cost that is over and above the rates that your plan covers would be your responsibility. The providers are also allowed to charge their patients administration fees which are not covered by the Scheme.
With regards to the consultation fee's, the rate charged by your provider is higher than the Scheme's reimbur*****t rate and therefore you would be responsible for the balance of the account. I emailed you an email with the details.
I understand that this is not the outcome you expected however, I trust this explains the reason for the non-payment of your claim.
Kind regards
Rishana