1 reviews | Active since Jul 2011
Refusing to pay for Medical Treatment
<p>I am 10 weeks pregnant and suffering from Anemia quite severly. It is actually affecting my everyday life as I am constantly tired and always struggle to wake up or stay awake, at times I even fall asleep at work at my desk, it is not something I can control, so my Gynea decided that I needed an Iron infusion to help build up my red blood cells again as the Iron deficiency has broken down most of the blood cells. My husband is the main member and sent the query to Discovery with my blood test results, and ask them to please pay for this treatment, we get the response "Unfortunately we cannot pay for the requested treatment". In the same letter it states, Explanation: Iron deficiency anaemia secondary to blood loss (chronic) - PMB code description: Iron Deficiency; vitamin and other nutritional deficiences - life threatening.......Why do I then have medical aid if they are not even willing to help me with something that is life threatening? Where are your priorities? According to the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of: A defined list of 270 diagnoses.....On the list? Iron deficiency; vitamin and other nutritional deficiencies – life-threatening.....I await your response....</p>
Dear Kriz88
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
Dear Kriz88
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
Dear Kriz88
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Dear Kriz88
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Dear Discovery Health Servicing Team...
I have never in my life had such a ludicrous phone call. The only reason you declined my application was because the prescription was from a Gynea and not a GP?? How ridiculous!! Where is a pregnant woman supposed to get her prescription from?? I do NOT accept your phone call as a valid one, you may as well not have phoned me. I expect you to come up with a better answer than this because I am not going to drop this. Furthermore, I now had to send an appeal letter to my GYNEA to provide motivation as to why I needed the treatment. This is not even related to WHY you declined my application!!! My blood test results showing that I have NO Iron in my body should be motivation enough!!! Please use the phone call's recording in training and advise your service agents how NOT to handle an angry client.
Dear Discovery Health Servicing Team...
I have never in my life had such a ludicrous phone call. The only reason you declined my application was because the prescription was from a Gynea and not a GP?? How ridiculous!! Where is a pregnant woman supposed to get her prescription from?? I do NOT accept your phone call as a valid one, you may as well not have phoned me. I expect you to come up with a better answer than this because I am not going to drop this. Furthermore, I now had to send an appeal letter to my GYNEA to provide motivation as to why I needed the treatment. This is not even related to WHY you declined my application!!! My blood test results showing that I have NO Iron in my body should be motivation enough!!! Please use the phone call's recording in training and advise your service agents how NOT to handle an angry client.
Good day Kriz88
We can confirm that we have sent you final feedback by email.
Regards
Nirvana
Good day Kriz88
We can confirm that we have sent you final feedback by email.
Regards
Nirvana
Hi Nirvana, first I get the phone call telling me that my application was declined due to the prescription coming from a Gynea and not a GP, now I get an e-mail stating that it was declined because the dosage was 500mg and not 1000mg. If I can get my doctor to agree to increase the dosage to 1000mg (apparently you will now accept the prescription from the gynea) then Discovery will cover the medication. Nirvana, is that not a bit dishonest? Why do I have now have 2 different reasons for the decline which are actually contradictive? Nope, still not happy with this, there is no valid explanation for Discovery to decline this. I am now going to escalate this to higher management and should I still not get any joy or any valid explanations, I will be going to all social media outlets. I look forward to the next excuse.
Hi Nirvana, first I get the phone call telling me that my application was declined due to the prescription coming from a Gynea and not a GP, now I get an e-mail stating that it was declined because the dosage was 500mg and not 1000mg. If I can get my doctor to agree to increase the dosage to 1000mg (apparently you will now accept the prescription from the gynea) then Discovery will cover the medication. Nirvana, is that not a bit dishonest? Why do I have now have 2 different reasons for the decline which are actually contradictive? Nope, still not happy with this, there is no valid explanation for Discovery to decline this. I am now going to escalate this to higher management and should I still not get any joy or any valid explanations, I will be going to all social media outlets. I look forward to the next excuse.
UPDATE: Received a phone call at 13:21 today from the person who sent the above mentioned e-mail. According to him I am confused....no, I think discovery is getting confused and mixed up with their excuses....shame. I explained to him that if I go back to my dr to get the amended prescription for 1000mg as Discovery obviously knows whats best for me and my Dr does not, I told him that the prescription will come from that same Dr that they declined in the first place. And his next words were....."It doesnt matter who the prescribing Doctor is".....so either you sir are LYING to me or the lady on Friday **** to me. I wonder who is confused. As I told Shaun, I dont want to speak to the call centre or their team leaders, get your Higher Management to listen to all these phone calls and lets see if they can then call me and come up with a better excuse. You are digging a very deep hole Discovery....
UPDATE: Received a phone call at 13:21 today from the person who sent the above mentioned e-mail. According to him I am confused....no, I think discovery is getting confused and mixed up with their excuses....shame. I explained to him that if I go back to my dr to get the amended prescription for 1000mg as Discovery obviously knows whats best for me and my Dr does not, I told him that the prescription will come from that same Dr that they declined in the first place. And his next words were....."It doesnt matter who the prescribing Doctor is".....so either you sir are LYING to me or the lady on Friday **** to me. I wonder who is confused. As I told Shaun, I dont want to speak to the call centre or their team leaders, get your Higher Management to listen to all these phone calls and lets see if they can then call me and come up with a better excuse. You are digging a very deep hole Discovery....
UPDATE: On Monday 5 September I received a phone call from Meril (?spelling) advising that they need to obtain the blood results and contact the doctors that in previous years diagnosed the condition, i gave her my consent. Havent heard anything since, however, yesterday (Tuesday) I received a phone call from my Gynea's office telling me that they were again approached to right a report on why the oral tablets did not work. The doctor already gave motivation TWICE, why harrass my gynea just becuase you guys are not ontop of your game. I expect further communication today as to what your next step is going to be!! I have waited LONG enough now and getting quite impatient. Poor taste Discovery!!
UPDATE: On Monday 5 September I received a phone call from Meril (?spelling) advising that they need to obtain the blood results and contact the doctors that in previous years diagnosed the condition, i gave her my consent. Havent heard anything since, however, yesterday (Tuesday) I received a phone call from my Gynea's office telling me that they were again approached to right a report on why the oral tablets did not work. The doctor already gave motivation TWICE, why harrass my gynea just becuase you guys are not ontop of your game. I expect further communication today as to what your next step is going to be!! I have waited LONG enough now and getting quite impatient. Poor taste Discovery!!
Shaun....why are you now all of a sudden phoning my husband?? Do you think he will then accept the excuses after I have been fighting this all along? When this started you were phoning ME and e-mailing ME....now all of a sudden you are contacting my husband while I sit and wait for someone to give me feedback!! Regardless of the fact that he is the main member, I am laying the complaint!! I expect you to phone ME and tell ME what is going on!! This is not on!
Shaun....why are you now all of a sudden phoning my husband?? Do you think he will then accept the excuses after I have been fighting this all along? When this started you were phoning ME and e-mailing ME....now all of a sudden you are contacting my husband while I sit and wait for someone to give me feedback!! Regardless of the fact that he is the main member, I am laying the complaint!! I expect you to phone ME and tell ME what is going on!! This is not on!
Good day Kriz88
I have provided you with an email detailing the funding decision and your concerns raised.
Regards
Meryl
Good day Kriz88
I have provided you with an email detailing the funding decision and your concerns raised.
Regards
Meryl
As expected, after all my weeks of pleading and begging, Discovery walks away from this smiling and me the patient, still ending up with nothing. Even with the motivation and documentation they required. My questions are being dodged and their answers are just repeated and completely contradictory. Still not happy or satisfied......thanks Discovery for nothing. You are not worth my stress at 13 weeks pregnant!
As expected, after all my weeks of pleading and begging, Discovery walks away from this smiling and me the patient, still ending up with nothing. Even with the motivation and documentation they required. My questions are being dodged and their answers are just repeated and completely contradictory. Still not happy or satisfied......thanks Discovery for nothing. You are not worth my stress at 13 weeks pregnant!