Policy to be cancelled

Recently I have had to make use of my Discovery Medical Aid. Through this experience, I have decided to cancel my policy. It is not that the rules of the policy are at fault, but more the service I had around those rules that have made me make that decision.

Essentially it is about support personnel training.

My most recent experience was me needing to get an appointment to see an Ent. Now if you had told me that the Ent service was not covered, I would have been fine. But there is no direct way for me to find that out. I have to go through the whole procedure. That means the following:

1. Going to the Doctor to get seen about the condition, and getting the doctor to ask Discovery for authorisation. That may sound easy enough. But doctors are busy. And often or not, my doctor would not do the submission at the consultation. In fact, it is in their interest to not do it at the consultation. They only get paid R250 for the consultation, with their normal price being R540. So it makes sense for the doctor to do the consultation on one day, and then do the submission for the authorisation on another. Thus being able to charge twice. Why not. But factor in that sometimes they forget. So added into this is me having to follow up.

2. Getting the authorisation declined. I have had a few of these. In each of them, the reason for the decline wasn't correct. My most recent one came back saying that I can't ask for authorisation retrospectively. In other words, they thought that I had already been to the specialist, and was now asking for authorisation. This wasn't correct. In the past I have had similar issues, where the reason for declining was incorrect. That means I now need to phone and find out. When speaking to the service consultant, they would not be able to tell me why. I am not sure why this is. I have never had them be able to tell me straight off. This is where we have a problem in their system. So now they either need to guess, or they need to escalate. So we had a two day wait for the authorisation to be declined, and now we have another day at least for it to be escalated. At this point I will now know why it was declined.

So take a look at what this took me. The visit to the doctor would have been at least an hour. Another half hour to 45 minutes at least to get through to a consultant and get them to try and figure things out, and then escalate the issue. And then probably another half hour to get the feedback on the escalation. And if what I was asking for was just a consultation with a specialist, they are only going to pay me R540 for the R1500 + visit to the specialist. Was that worth nearly 3 hours of my time. No way.

Then add in the frustration. Add in the painful on-hold music. And by the way, I think they do this deliberately. They make the on-hold music sufficiently painful, and sufficiently long, that you will drop the call. I really think they do this on purpose. I have logged calls for them to specifically change their music. This is almost the entire reason I want to cancel the policy. The on-hold music is that bad. One song, cut into pieces, being played again and again. And the worst piece of music you could imagine.Then add in the fact that you have to listen to it for up to half an hour, and the sometimes another half an hour while the consultant reviews your case or gets more information or consults with their supervisor. It is maddening.

What is at fault here? Let me break it down:

1. There needs to be clearer explanation of the Prescribed Minimum Benefits (PMB). I should have a list that I can refer to. Not sure why I don't have this.

2. The consultants should be trained on the PMB. Not one of the ones I have ever spoken to have been able to answer questions relating to this. Their viewpoint is always that I need to ask for authorisation, and go through the whole procedure to find out. I find that unacceptable.

3. Doctors on their network should be trained on the PMB. At the consultation they should be able to say straight away that the procedure would not be covered, and tell me not to waste my time.

4. The system that the doctors get to ask for authorisation should have the PMB built in. The moment the doctor enters the ICD10 code, and the provider type, the system should be able to say that it is not covered. This is a really simple place to start. Why leave it to the people doing the authorisation when the rules are fixed, and the rules can be coded. Sure, there should be a way to bypass the system and go ahead and ask for authorisation if you really want to. But why make all of this extra work. Just put it in the system where it belongs.

5. There should be a place where me as a policy holder can check these kinds of things. When I eventually asked ChatGPT why I wasn't getting authorisation (I didn't really get a good reason from the consultant), I got a really good answer, and it was explained correctly. There should be no reason why Discovery could not do a similar thing. Why is it that ChatGPT is more trained than their own consultants.

6. Do something with the on-hold music. At least remove the music altogether if you aren't going to provide and extended music repertoire. Go back to a beep-beep, or just silence. There is no reason to make people mad with a really bad choice of one song.