Pre Authorisation Unduly Rejected

<p>Hi</p> <p> </p> <p>It's unfortunate that consumers need to resort to these measures before being taken seriously. Being in a client liason position for one of the biggest brands in South Africa and having to deal with Hello Peter complaints, Id never thought I'd have to resort to using this forum. </p> <p> </p> <p>Before I share my experience, Id like to mention that Discoverys call centre agents are absolutely phenomenal with regards to service. I truly believe other corporations should take a leaf out of their model in this regard.</p> <p> </p> <p>My experiences with the pre Authorisation department is totally contradictory to this. </p> <p> </p> <p>Last year, I took out a medical scheme seeing that I was changing roles which required me to travel and found it necessary to do so. I fell ill about three weeks after inception of policy. I originally made a claim which was rejected about 6 weeks after. Understandably, it may have appeared as if it was a simple case of non disclosure, though the illness I faced was totally unrelated to the illnesses I disclosed. After numerous calls and more than a week delay, I was called by a very rude agent to state that the claim was rejected. While trying to explain my predicament she blunty mentioned a few words and cut the call. Due to time constraints and not particularly in the mood to fight it, I let it be. </p> <p> </p> <p>A few months down the line, I request pre Authorisation for a mini procedure that needed to be undertaken, I was called two days later stating that the claim was rejected due to non disclosure. Once again, the issues I faced are non related at all to the disclosed issues. I was told that my doctor mentioned on the Pma form that I've had the symptoms for over four months. Discovery interpreted it as four months before I took out the policy and not four months of symptoms since my last doctor visit which was last week. </p> <p> </p> <p>I'm not certain whether discovery have changed their stance on approvals due to their current financial dilemma or purely due to an *********** approvals department. Forgetting the legal standpoint surrounding this (which favours my person, particularly in the event my health drastically deteriorates) the ethical grounds of such leaves much to be desired. </p> <p> </p> <p>Regards </p> <p> </p> <p> </p>