Reimbur*****t

<p>I have been battling with Discovery for the past two weeks to get my script which was given by a Key care Doctor reimbursed. I have spoken to numerous agents in December who advised that this in fact is on the prescribed medicines list and that Discovery will pay for it?</p> <p> </p> <p>I proceeded to send my claim of which I was told it was not paid/rejected as the scheme does not cover this.</p> <p>I received the below response when I further escalated the matter.</p> <p>Membership number: ********** 70</p> <p>Reference number: ********** 335</p> <p>Claim query</p> <p>We have received your request with regards to Mr Meyer's membership.</p> <p>The claim for Clicks Pharmacy Melkbos has been processed as follows:</p> <p>Treatment date<br />Amount claimed<br />Amount paid<br />Paid to<br />Reason code<br />Date of payment<br />2017/02/20<br />R 571.55<br />R 0.00<br />None<br />751<br />03/03/2017<br />Reason code 751: We have not paid the amount on this line, as the quantity requested is more than is allowed for this period.</p> <p>Kindly note that the medication is on the formulary but the quantity the GP has asked for is more that the plan allows, the member will be allowed 20g every 120 days.</p> <p>If you have any more questions with regards to this query, please email ********** and quote the above reference number as well as the membership number. Please note that this email address is for queries of an escalated nature. All first time queries can be emailed to ********** <p>Regards</p> <p>Jonathan Mclean<br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p> </p> <p>==============================================</p> <p>I provided them with the recording references for them to listen to but yet this is what I receive. I further went to check on their Medicine app just to check whether they cover this. Low and behold there it says that It clearly states that DISCOVERY WILL PAY FOR THE MEDICINE IN FULL IF PRESCRIBED BY A CHOSEN KEYCARE GP.</p> <p>I have sent screen shots to Discovery as well as it clearly states it willbe paid from KEYCARE BENEFIT irrespective of the amount which has been prescribed.</p> <p>I have also checked what they do not pay for like the Persivate Ointment in 500g. I was dispensed the cream and not an ointment.</p> <p>But yet this is what was received a few minutes ago.......</p> <p>Membership number: ********** 70</p> <p>Reference number: ********** 242</p> <p>Claim query</p> <p>We have received your request with regards to your membership. Kindly note that the medication can only be given in certain quantities and if the correct amounts were given, the medical aid would refund you the amount that has been paid. If the medication was prescribed under the correct quantity amount, the claim would have been covered from your day-to-day benefits and you would not have had to pay for the medication.</p> <p>I do apologise for the inconvenienced that has been caused.</p> <p>If you have any more questions with regards to this query, please email ********** and quote the above reference number as well as the membership number. Please note that this email address is for queries of an escalated nature. All first time queries can be emailed to ********** <p>Regards</p> <p>Jonathan Mclean<br /> Discovery Health (Pty) Ltd <br /> On behalf of Discovery Health Medical Scheme</p> <p> </p> <p>Very pathetic service .......proof given numerous times wording by discovery on their website?</p> <p>Still waiting for my money as has the claim been processed it would have been paid into my banking account already.</p> <p> </p>