Poor Service & Communication

<p>I am a longstanding Discovery Health Essential Saver member and was admitted to hospital (Cape Town MediClinic) to undergo urgent surgery on 28th November 2016. I was required to settle the said surgery bill (ZAR 14k) in full directly with the medical practitioner (Dr N. Novikova) and then submit the claim to Discovery Health for processing. At the time, Discovery reimbursed 100% of the said surgery costs accordingly. On 10th July 2017, approx. eight months after the aforementioned events, I received an unexpected email from Discovery Health to advise that the surgery claim payout will now be reversed as follows:</p> <p><br />"Payment from the Scheme:<br /> <br />Novikova N<br />R 4 131.80<br /> <br />R 4 131.80<br />Less amount owing to the Scheme:<br />R 14 998.47<br /> <br />Amount you still owe the Scheme:<br />R -10 866.67<br /> <br />You will notice that the total amount has been reduced by R 14 998.47, which you owe to the Scheme. We have deducted this amount from the total payment. However, because the amount you owe the Scheme is larger than the payment due to you, you are still left with an amount owing to the Scheme. We will deduct this from future claim amounts owing to you".</p> <p> </p> <p>No reason(s) whatsover have been provided by Discovery Health as to why the payout has suddenly been reduced and/or reversed several months after the original claim? Further, I've since received a letter dated 21/07/17 requesting that I kindly settle my 'claim reversal debt' of ZAR 10 866, a significant amount of money and unforseen expense, which is contrary to Discovery's original email communication advising that this figure would be "deducted from future claims owing to the Scheme'. </p> <p> </p> <p>Moreover, the specialist anaethetist (Dr A Aubin) who treated me for the very same surgical procedure, sent written correspondence to the principle officer at Discovery Health dated 30th November 2016 arguing that his fees for surgery (ICD-10 code: D27,R10.2) fall under the Prescribed Minimum Benefits of the Medical Schemes Act (code: 434M), and should be reimbursed in full without any co-payment by the patient (I had to settle a portion of his costs directly). To date, there has been zero response in the latter regard from Discovery Health. </p> <p> </p> <p>All in all, such poor service and communication is unacceptable by any standards, and certainly not what one expects from a medical aid provider of the calibre of Discovery Health. A response clarifing the necessary would be appreciated. </p> <p> </p> <p>Thanks, </p> <p> </p> <p>R. April </p>