TS
Tamsyn S
1 reviews | Active since May 2014
20 Feb 2021, 10:00
Play fair
As a service provider I am at my wits end with Discovery Health. Every single week I am dealing with errors in processing claims. The current favourites are rejecting claims for missing information (which is never actually missing) or paying claims directly to the members instead of to the practice and then taking weeks to rectify their mistakes. Come on Discovery - I play your game, charge your rates and stick to your rules. The least you can do is pay my practice efficiently and correctly.
Helpful (0)
Replies (6)0
Replies (6)
Discovery Health's replyOfficial
22 Feb 2021, 06:45Dear Tamsyn
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
Discovery Health's reply22 Feb 2021, 06:45
Official
Dear Tamsyn
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
Discovery Health's replyOfficial
22 Feb 2021, 15:44Dear Tamsyn
We’ve contacted you regarding your complaint.
Regards Discovery Health Servicing Team
We’ve contacted you regarding your complaint.
Regards Discovery Health Servicing Team
Discovery Health's reply22 Feb 2021, 15:44
Official
Dear Tamsyn
We’ve contacted you regarding your complaint.
Regards Discovery Health Servicing Team
We’ve contacted you regarding your complaint.
Regards Discovery Health Servicing Team
TS
Tamsyn S's updateReviewer Update
23 Feb 2021, 06:03 Claim paid to memberWe do not have a Payment Agreement with the Practice; we cannot reverse the amount from the member.I apologise for the inconvenience and added effort.
This is an unacceptable response from Discovery Health. They paid the money incorrectly to the member with NO proof of payment. The claim was specifically marked for payment to the practice. This is basically theft from the practice and now they are unwilling to assist.
Further, claims have in the past been reversed and redirected to the practice when this error was made, but now they are throwing their hands in the air?
This is an unacceptable response from Discovery Health. They paid the money incorrectly to the member with NO proof of payment. The claim was specifically marked for payment to the practice. This is basically theft from the practice and now they are unwilling to assist.
Further, claims have in the past been reversed and redirected to the practice when this error was made, but now they are throwing their hands in the air?
TS
Tamsyn S's update23 Feb 2021, 06:03
Reviewer Update
Claim paid to memberWe do not have a Payment Agreement with the Practice; we cannot reverse the amount from the member.I apologise for the inconvenience and added effort.
This is an unacceptable response from Discovery Health. They paid the money incorrectly to the member with NO proof of payment. The claim was specifically marked for payment to the practice. This is basically theft from the practice and now they are unwilling to assist.
Further, claims have in the past been reversed and redirected to the practice when this error was made, but now they are throwing their hands in the air?
This is an unacceptable response from Discovery Health. They paid the money incorrectly to the member with NO proof of payment. The claim was specifically marked for payment to the practice. This is basically theft from the practice and now they are unwilling to assist.
Further, claims have in the past been reversed and redirected to the practice when this error was made, but now they are throwing their hands in the air?
TS
Tamsyn S's updateReviewer Update
23 Feb 2021, 13:48 Kindly be advised that the account has been processed to the member. The claim will reflect on the practice’s claims statement number 02.
Kindly query payment with the member.
Kindly note that you may access the following tools on the Discovery website:
If you have any more questions, please call us on ***or email ***. Alternatively, you can access the website at www.discovery.co.za.
Regards
Naeem Lambat
Discovery Health
Um yes, hence my complaint in the first place. Just goes to show that the consultants are working from a decision tree / spreadsheet of standard responses with no thought given to the matter at hand and no real problem-solving app****.
Kindly query payment with the member.
Kindly note that you may access the following tools on the Discovery website:
- Statements (not older than 6 months)
- Claims search
If you have any more questions, please call us on ***or email ***. Alternatively, you can access the website at www.discovery.co.za.
Regards
Naeem Lambat
Discovery Health
Um yes, hence my complaint in the first place. Just goes to show that the consultants are working from a decision tree / spreadsheet of standard responses with no thought given to the matter at hand and no real problem-solving app****.
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Tamsyn S's update23 Feb 2021, 13:48
Reviewer Update
Kindly be advised that the account has been processed to the member. The claim will reflect on the practice’s claims statement number 02.
Kindly query payment with the member.
Kindly note that you may access the following tools on the Discovery website:
If you have any more questions, please call us on ***or email ***. Alternatively, you can access the website at www.discovery.co.za.
Regards
Naeem Lambat
Discovery Health
Um yes, hence my complaint in the first place. Just goes to show that the consultants are working from a decision tree / spreadsheet of standard responses with no thought given to the matter at hand and no real problem-solving app****.
Kindly query payment with the member.
Kindly note that you may access the following tools on the Discovery website:
- Statements (not older than 6 months)
- Claims search
If you have any more questions, please call us on ***or email ***. Alternatively, you can access the website at www.discovery.co.za.
Regards
Naeem Lambat
Discovery Health
Um yes, hence my complaint in the first place. Just goes to show that the consultants are working from a decision tree / spreadsheet of standard responses with no thought given to the matter at hand and no real problem-solving app****.
TS
Tamsyn S's updateReviewer Update
24 Feb 2021, 06:06And here we go again:
Reason for short- or non-payment1025 | We have not paid this claim because there is no practice number for the referring doctor on the claim. Please resubmit the claim with the required information.
Only ALL the required information is on the claim.
Reason for short- or non-payment1025 | We have not paid this claim because there is no practice number for the referring doctor on the claim. Please resubmit the claim with the required information.
Only ALL the required information is on the claim.
TS
Tamsyn S's update24 Feb 2021, 06:06
Reviewer Update
And here we go again:
Reason for short- or non-payment1025 | We have not paid this claim because there is no practice number for the referring doctor on the claim. Please resubmit the claim with the required information.
Only ALL the required information is on the claim.
Reason for short- or non-payment1025 | We have not paid this claim because there is no practice number for the referring doctor on the claim. Please resubmit the claim with the required information.
Only ALL the required information is on the claim.
TS
Tamsyn S's updateReviewer Update
24 Feb 2021, 06:11And this one:
Reason for short- or non-payment45 | The amount claimed is higher than what the Scheme will pay.
Only VERY code was charged at the exact Discovery tariff. So now this claim has been paid out to the member AGAIN for no good reason.
Reason for short- or non-payment45 | The amount claimed is higher than what the Scheme will pay.
Only VERY code was charged at the exact Discovery tariff. So now this claim has been paid out to the member AGAIN for no good reason.
TS
Tamsyn S's update24 Feb 2021, 06:11
Reviewer Update
And this one:
Reason for short- or non-payment45 | The amount claimed is higher than what the Scheme will pay.
Only VERY code was charged at the exact Discovery tariff. So now this claim has been paid out to the member AGAIN for no good reason.
Reason for short- or non-payment45 | The amount claimed is higher than what the Scheme will pay.
Only VERY code was charged at the exact Discovery tariff. So now this claim has been paid out to the member AGAIN for no good reason.