Outstanding Claim since July (Worst Service I have received ever)

<p>On the 14th of July I got diagnosed with Asthma after being sick for 3 months and landed in the hospital with pneumonia. I Saw a pulmonologist Dr G Ras. who diagnosed me as ashmatic after losing some of my lung function. He did lung function tests and diagnosed me with Asthma and gave me a prescription which was approved by Discovery on my Chronic benefit. With this Chronic benefit the diagnosis is paid for and I confirmed that Discovery would pay for this diagnosis test and consultation out of my chronic benefit. I proceeded as per instruction to submit the claim and in the detail specified that it needs to be paid out of my Chronic benefit. I waited 3+ days and received a email from Discovery which stated that i did not have enough savings in my medical savings account, and that the claim has been rejected for payment. I phoned Discovery and spoke with one of the Chronic department consultants who explained that I would need to re-submit the claim and that the claim would be paid. I resubmitted the claim again had to wait 3+ days and received the email which stated that i do not have enough funds in my medical saving account which is not the account I have multiple times requested that the claim needs to be paid out of my chronic benefit. I phoned Discovery again and spoke to a consultant in the Chronic department who explained that the ICD-10 code which the docter supp**** on the invoice J45.5 is not the correct ICD-10 code and I would have to have it changed to J45.9. I phoned the docters office and asked them to use J45.9 instead of J45.5. The docter changed the code and resend me a statement. I then Phoned Discovery again and re-submitted the claim with the correct ICD-10 code as requested. AGAIN had to wait 3+ days for email which stated the claim has been rejected due to not enough funds in my medical saving account....... I phoned Discovery and asked to speak to a manager as this has been going on for almost 2 months at the time, I was put through to Fredelise who I explained my claimhas been outstanding since July and that I was promised multiple times that it would be paid..... she looked on the system and she told me that i did not have enough money in my savings account.... I then explained the entire process and flow of events to her gave her the multiple reference numbers I have which I can supply..... After this she said she would look into the problem. I waited a week and a half and recieved an email that I do not have enough FUNDS IN MY MEDICAL SAVINGS ACCOUNT.... then phoned and left a message to speak to Fredelise. She phoned me back saying that she has bad news and the claim will not be paid???? I asked why and her response was that the docters practice number indicated that he is a pulmonologist and because of this they will not pay this account. She explained that I had to go the a general practitioner to get this paid under chronic benefit......I then rep**** saying that my lungs was not suppling oxygen to my organs causing my heart to start beating eratticly and landing me in the emergency room and you are saying that I should have gone to my GP which I have been going to for the pervious 3 months of being sick and the actual reason my medical SAVINGS is depleted to get diagnosed with a lung problem rather than going to a lung specialist and she rep**** yes... I then asked for this in writing. She then rep**** and said that she would confirm this and get back to me she then got back to me and confirmed this was not the case and the account would be paid out of my chronic benefit. Another week went by and she contacted me sying the account will be paid but the ICD-10 code was incorrect and this is the reason it has not been paid so she said the ICD-10 code has to be J45.9 not J45.5 in response was ........ THAT IS WHAT IT WAS BEFORE DISCOVERY ASKED ME TO HAVE IT CHANGED.... so I said she should look at the documents I already submitted and gave her the reference numbers she asked me to resubmit the documentation..... I did submit the documentation... Fredelise contacted me and said she got confirmation that the claim has been approved and will be paid into my account... I thanked her and yet again a few days later received a email stating THAT I DO NOT HAVE ENOUGH FUNDS IN MY MEDICAL SAVINGS ACCOUNT AND THAT THE ACCOUNT HAS ALREADY BEEN PROCCESSED AND HAS BEEN REJECTED. Thus I phoned Discovery YET Again for the +/- 30th time and Navashni,Lee,Fredlise told me that it was a system problem and it would be paid and fixed... they apologised for the INCONVIENCE..... and I received 2 additional emails that day stating that I do not HAVE ENOUGH FUNDS IN MY MEDICAL SAVINGS ACCOUNT.... Fredelise who promised to phone me the next day did not the follwing day she phoned me and apologised as her daughter was sick she could not have phone me back which I can understand and accepted. Again I was promised that the claim has been approved and the payment would be arranged manualy as there is a system problem!!!!!! Up and till today I ahve not received payment and since has had another email stating that I do not have enough funds in my medical saving account. I feel the empty promises and poor customer service is not what one would expect for one of the biggest and supposedly best medical aid scheme in South Africa. I am bitterly dissapointed in Discovery health.</p>