1 reviews | Active since Feb 2012
not authorising claim. bad service.
I took out medical aid for my mother in the month of may. and they called her to do underwriting and we filled in all the forms regarding her health. last week my mom suffered from ulcer and I took her to a g.p which referred us to dalview hospital for my mom to get checked. my mom was admitted last week Wednesday and discharged on sat and informed to come back yesterday for a gastroscopy. yesterday she went back and today hospital informs us discovery refuses to authorise the gastroscopy for my mother. I called discovery and they informed me they are investigating for non disclosure as my mom got ill within 12 months of cover. firstly they do not inform me of reasons for not authorising till I call them. secondly we are treated like ********** and *********. I work for a financial industry so I know very well about disclosing information. had they not wanted to cover my mom they should've said so or went and done medical tests. however I don't appreciate that my mom had to be lying in hospital without assistance yet I pay medical aid for ridiculous service. I wasn't obliged to take discovery there are many health schemes little did I know I would get such bad service.
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there was any pre-existing conditions of which we were not aware. Due to the Confidentiality Act, the Scheme is unable to provide you with any information on the membership unless we receive written permission from the policy holder confirming you as the appointed party. We are looking into the issue and will be in contact with the policy holder to provide feedback.
Kind regards
Bruce
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there was any pre-existing conditions of which we were not aware. Due to the Confidentiality Act, the Scheme is unable to provide you with any information on the membership unless we receive written permission from the policy holder confirming you as the appointed party. We are looking into the issue and will be in contact with the policy holder to provide feedback.
Kind regards
Bruce