1 reviews | Active since Sept 2013

06 Feb 2015, 11:31

Processed claim incorrectly, delayed payment etc

This query initially started with me submitting two claims for the same doctor Monday 02/02/2015 at 08:18 via one email. I spoke to a consultant shortly afterward who confirmed the claims were legible. I called back on Tuesday 03/02/2015 & spoke to Mogamat Salie. His service was shocking & I was eventually transferred to Lindi (Service Specialist). I asked her to expedite the claims and report the poor service to Mogamat Salie's TC (Margy). Later the same day Margy called. She informed that the claims would not be paid in full because they have an agreement in place with the doctor. She apologised for the poor service experience and offered to log an inquiry to pay the difference of the claims since my MSA was set to pay at Cost. On Wednesday 04/02/2015 Margy called me to inform they have processed the claims and will do the reprocessing shortly afterward. She said they would first pay the amounts as agreed then the difference. On Thursday 05/02/2015 I spoke to Lyle at 11:20. He confidently told me the claims would be paid as Margy informed. I asked him to get Margy or Lindi to call me back ASAP. This did not happen!! I have only received payment for the smaller claim thus far!!!

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Replies (1)
Discovery Health
Discovery Health's reply06 Feb 2015, 18:11
Official
Hello Your client ,

Thank you for your comment.

I am currently investigating the details of your query and will keep you updated.

Kind regards
Rishana