JM
Jacques M

1 reviews | Active since Aug 2009

19 May 2020, 10:53

Prescribed Minimum Benefit Incorrect Claim Allocation

I received confirmation from Discovery Health on the 19 March 2020 that my Prescribed Minimum Benefit (PMB) was approved, MailRef#***#- According to the approval conditions received it states that: - Discovery will payout according to the approved amounts - Thant my day-to-day benefits will not be impacted However the conditions were not properly app****, as when the medical practitioner send through claims (24 April 2020) against the pre-approved PMB Diagnosis codes, claims were paid, not paid or partially paid. For instances where claims were not paid or partially paid, the remainder of the amounts where deducted from my Medical Savings Account, resulting in my full Medical Savings being depleted for 2020. The medical practitioner has queried this with Discovery more than a month ago without any resolution. I have also queried this without any resolution from the 4 May 2020 without any resolution – refer to reference numbers and interactions below: Reference Number: ***– Closed however not resolved Reference Number: *** – Closed however not resolved Reference Number: ***– Closed however not resolved Reference Number: ***- Still no feedback received Each time I call the Call Centre a new Reference number gets logged, and I get told the issue is being handled by another department, being shifted from pillar to post! As a paying member of my medical aid, I would like to request a FULL reconciliation of this Prescribed Minimum Benefit MailRef#***#-, the claims submitted against this PMB, proper reasons why claims against the PMB were not paid and partial paid – although codes were approved, and reasons why not paid and partial paid claims were deducted from my Medical Savings account. I would appreciate your cooperation it this regard and to have this issue resolved by COB 28 May 2020

0
Replies (2)
Discovery Health
Discovery Health's reply20 May 2020, 08:23
Official
Dear Jacques M 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
Discovery Health's reply21 May 2020, 09:22
Official
Dear Jacques M We’ve contacted you to discuss your query. 
   
Regards Discovery Health Servicing Team