JH
Justin H

1 reviews | Active since Jan 2010

08 Jan 2019, 16:18

Out of hospital maternity benefits leave a lot to be desired

My wife has given birth to our first child in December via c-section and we generally happy with the Discovery benefits, especially the in-hospital costs. However, the out of hospital benefits are not satisfactory in the method to access the benefits and the transparency by Discovery. We are on the Coastal Core therefore do not expect great out of hospital benefits but the following has not gone down well in explanation of declined claims or the manner in which it unfolded and mostly seems a marketing hype to make a great sounding maternity benefits package:

1. missed out on the initial claim for the first blood tests and obstetrician visit as we did not according to Discovery, go online and activate the "my pregnancy" benefit. As a medical aid plan that covers pregnancy we would not expect an online activation from preventing us from claiming and besides, is the first visit to the obstetrician not supposed to confirm the pregnancy? It does not make sense to activate a benefit upfront based on a home pregnancy test. Surely the first visit to an obstetrician where the doctor medically confirms the pregnancy should override the fact that we did not log onto the discovery website and click a button. We did take this up with the Discovery principal officer but did not get anywhere, have not had the time to take up with the ombudsman yet but will do so.

2. Checked with Discovery and was advised they cover antenatal classes at the "discovery rate" for 5 classes and it is based on industry research. The agent could not give be a Rand value. Strange as when we tried to claim, they came back when an exact Rand figure of R106 per class so why is this not made visible upfront? As our course was 3 classes it means we would only receive R318 for classes that cost R1700 in total. Very misleading as no registered nurse in the Western Cape offers a class for under R500 therefore this creates an incorrect impression that most of the cost would be covered, not less than 20%. Nevertheless Discovery keeps rejecting the claim after 2 attempts, stating that I have no medical savings, they cant seem to allocate against the maternity benefit. This benefits seems to be all about marketing and not practicality, rather leave it out of your offering Discovery.

3. Lastly, the final heart rate monitor session claim at the obstetrician was declined. Yet we have not used up the "ultrasound scans and prenatal screening" or "antenatal consultation" benefits. Surely this would fall under a prenatal screening or antenatal consultation?

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Replies (2)
Discovery Health
Discovery Health's reply08 Jan 2019, 16:39
Official
Dear  justin9999 

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.

Regards
Discovery Health Servicig Team
Discovery Health
Discovery Health's reply11 Jan 2019, 11:58
Official
Dear  justin9999 

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicig Team