EB
Elsabe B

1 reviews | Active since Jan 2018

31 Jan 2018, 15:43

Provided faulty information leaving me with the cost

Based on past experiences of going ahead with healthcare services without contacting Discovery to check if its covered, I did the smart thing this time to ask first,but looks like even that will not help you to get your claim paid even if they say it will be covered.

Basically I was considering moving to a higher plan at the end of last year and looked at the Classic smart plan as an option. One of the benefits is that you will be covered for 12 scripts a year with a co-payment of R10 per script for specific categories of medication. I am almost never sick and use only two types of medication every month which requires a script. So before joining the plan I decided to find out if Yasmin will be covered as I get this script monthly. Upon contacting Discovery to ask whether this medication is covered I was told in writing that in fact yes it was. That meant that I will save almost R2000 on medication for the year which is why I decided to change my plan to the classic smart option. You can imagine my surprise when I went to fill my script for Yasmin in January and was told it was not covered. After sending an email I was told that it was not covered by my plan by the discovery agent. I then sent the email I received indicating that it is covered as received from discovery previously. I received an email back that the claim has been sent for reprossessing and then received no further feedback. I then called discovery to find out whether I will be refunded and if it will be covered going forward. I was told yet again that it is not covered and will not be for the rest of the year even though I have written confirmation that it is covered. The agent said that I was misinformed and that they will go through a process of trying to refund the amount for January but that it will not be covered for the rest of the year. I am extremely upset as I will now have around R1800 expenses for medication which I wouldnt have had and now pay almost R500 more a month for a higher plan which does not really give me the benefit I signed up for. Since my decision to join this sceme was soly based on advice directly from discovery I do not see why I need to pay for their mistake for the rest of the year?

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Replies (2)
Discovery Health
Discovery Health's reply01 Feb 2018, 10:33
Official

Dear elsabe-buys

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 reply02 Feb 2018, 14:21
Official

Dear elsabe-buys

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team