NG
Nitisha G

1 reviews | Active since May 2015

19 May 2015, 16:00

NOT HONORING CLAIM

I put in a claim to Discovery on the 23.4.2015 for a specialist visit. On the 05.05.2015 i was told my claim was rejected, this was after receiving a ref number from Discovery prior to my visit to the specialist and several emails as to why my claim was not paid out. According to Discovery it was a system error. After several more mails to my consultant i was told that the doctor is not on the network and that i will be paid the Discovery Rate. Prior to putting through a motivation, getting a referral number and putting in my claim and several mails from my side i was not advised the specialist is on on the network. I feel that it is unfair as a member I was not informed that the specialist will not be covered in full. I feel the onus lies on Discovery to advise the members that a certain specialist is on the network when a referral number is given from them.

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Replies (1)
Discovery Health
Discovery Health's reply25 May 2015, 17:07
Official
Hello niti****ovender,

Thank you for your comment.

I confirmed when you requested for an authorisation to visit a specialist, the approval details confirmed that the claim will fund at the Scheme rate. In the instance where you make use of non-designated service providers (DSP), you may experience a shortfall. As discussed, the claim you are referring to funded correctly as the provider is a non-DSP. I am sorry that I cannot provide you with a different outcome.

Thank you for allowing me to assist with your query.

Regards
Clinton