IU
Inam U

1 reviews | Active since Mar 2011

16 May 2018, 15:39

Pathetic Cusotmer Service from Discovery

I was admitted in the Waterfall Netcare Hospital due to not feeling well, for 3 days (17April-19April). I have Discovery Classic Smart Plan (hospital plan), and I’m paying R.2360 every month (for 2 members). After 3 weeks I received a mail from Discovery that I am liable of all the expenses in the hospital. Today, I went to the hospital, spend 4 hours, did a complete investigation on how do I got admitted ? Waterfall hospital uses B2B system to get authorization, Staff DO NOT CALL DISCOVERY FOR AUTHORIZATION. And it was authorized by Discovery system, Auth # ********** 9 under ICD Code : M61.00 (MOT). I called Discovery on 16May2018 at 12:42pm, spoke to Siba to find out what does that Auth Number means ? She was unable to answer my question and put my on hold for 12min, came back and told me that this Auth # ********** 9 is a rejection code and told me authorization was rejected by Discovery. According to the hospital on their B2B system, Authorization was accepted and therefore I was admitted. 1. How is it possible that Waterfall Hospital admitted me without any authorization from Discovery ? As per hospital policy, I would have needed to make an upfront payment which I was not requested, as Authorization was produced on B2B system, which is directly linked to Discovery Medical Aid. 2. Discovery staff keep on changing stories by saying someone called from Hospital, whereas Hospital DID NOT CALL DISCOVERY because they have B2B system in place ?

During my 3 days stay in the Hospital, there was a bill incurred R.8517.30 (ward) and R.1532.00 (Physiothe******), which Discovery refused to pay, saying no authorization was given. Person (Siba) was not helpful at all, and she did not want to do further research how did it happen !!!

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Replies (2)
Discovery Health
Discovery Health's reply16 May 2018, 16:14
Official

Dear iu96

We received your message and we’re looking into the matter.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply18 May 2018, 13:53
Official

Dear iu96

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

Regards
Discovery Health Servicing Team