1 reviews | Active since Mar 2018
PMB condition claims rejected non payment
I am a 68 year old pensioner I have been on discovery medical aid from June 2017 . My reason for joining discovery was because they come highly recommended by family and friends. I must just state that before coming to this point of writing this review i have tried over and over to contact them and to date i have not received any feedback from any of the various call center consultants that i have spoken with. On the inception of my new membership i was well informed of my specific condition waiting periods which comes to an end at the end of June 2018. I also had a general waiting period which fall away on the 01/08/2017 . This is how my story unfolds ,on the 27th of November 2017 i visited my GP for a general examination as i was experiencing some lower abdominal pain and discomfort and I was then referred by My GP to hospital where i was then admitted and seen too by a Specialist in a network hospital so to my Knowledge as a sick women these where network Doctors . I was discharged on the 29th November because there was no clear prognoses and the pain persisted to a point i could not even walk Dr suggested that I return on the 04th November 2017 to have colonoscopy and gastroscopy so that they could determine the cause of pain . on the 07th December I was rushed to casualty as I had sever pain and bleeding , Dr was called in and an emergency operation had to be performed as my Appendix was near rupturing as the blood results revealed ,A request for authorization was put through to discovery health and to date the authorization was never loaded. Discovery pre autho department said I had to wait 60 Hours. Dr said he can not wait as the infection levels in my blood where so high it was life threatening and he could lose me so the operation went ahead. This was a PMB condition nothing related to my condition specific waiting periods . The reason i mention this is that i was now supposed to be healing and recovering from this major operation but instead i have had nothing but stress as the accounts related to this procedure have all been rejected and the Doctors call me daily for payment which i do not have? I have reached out for assistance talking to case managers who then refer me to the medical aid directly and when i call the call center my airtime runs out again please NOTE i'm a pensioner and to call from a cell to 086 number is not cheap . I have sent endless emails ( to standards department ) and the response i get is "THANK YOU FOR USING THIS ADMIN TOOL WE HAVE RECEIVED YOUR ESCALATED REQUEST AND IT WILL BE PROCESS SOON" whats the use of this tool that apparently supposed to improve customer service??? every single consultant I spoken with from the start told the same story , the claims are rejected because the incorrect authorization number was loaded and it was condition specific ,,,,,Now please note again THIS WAS A PMB CONDITION nothing related to my condition specific waiting period. the ladies i spoke to in Keycare call center both called Siya assured me its been investigated and would be resolved in 24hrs , they also assured me that i would be called back and advised of the progress which they both never did? Three week later i had to call in again as no one had made contact with me to advise what was happening. I was requested to submit a PMA form which i did Twice and the Doctors motivation letter which again states this was a PMB . On the 23/02/2018 I thought I would give this one more attempt ,I spoke to Jeremy Raghunath Ref ********** 884 who was very professional and made me feel like i had finally found someone that was going to end this nightmare for me as i am now been hounded by calls daily from service providers that want their money which is understandable as its now 3 months since my operation. The call dropped while talking to Jeremy and he was good enough to call me back , He proceeded to tell me that the query was now with the cases mangers and should be resolved in 3 days , He said he was going to take this case on and make sure he calls me back by the Wednesday 28th February 2018 the latest to update me ? Today is the 12 March and to date I have not heard a word from Jeremy or the two other ladies who funny enough have the same name Siya from Keycare department . This for me is not just a stressful time but as an old women i can not afford to be calling and running around after people that make false promises this is so unprofessional and I am so disappointed at the service I have received thus far. I have even been advised to take this up with medical council and address this legally . I do not need this in my life at this age to be running to lawyers but if that's what it takes to be heard then I will have too start the process ,starting with hellopeter I hope that I will now be heard ! Regards Disappointed Discovery member
Dear Catz68
Thanks for bringing this matter to our attention. We’ll look into it and be in touch with you soon.
Regards
Discovery Health Servicing Team
Dear Catz68
Thanks for bringing this matter to our attention. We’ll look into it and be in touch with you soon.
Regards
Discovery Health Servicing Team
Dear Catz68
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Dear Catz68
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
