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Obakeng N

1 reviews | Active since Nov 2014

14 Nov 2018, 13:23

Rejected Claim

I have been going back and forth between the hospital and Discovery . Before I went to the hospital I have contact the call center on the 18th of October to inquire about the process of going to a specialist or hospital . I was advised so nicely that I first need to go to the GP get a referral letter and go see the specialist . Went to my GP as advised checked on the discovery website and ultra sound is covered on Key plus . Got the referral letter went to the Radiology and BOOOOM my claim was rejected because my plan does not cover this treatment or test . I was puzzled called in again on the 10th Nov and was advise no actually its covered will escalate for the claim to be reviewed. This one is a classic called again on the 13th spoke to Nokubonga Ngubane she advised me that actually your plan does not cover this will send you a KeyCare Radiology request form it shows what you are covered for , guess what the last item on the list is actually what the hospital claimed for .

Kindly assist in resolving this issue .

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Replies (3)
Discovery Health
Discovery Health's reply14 Nov 2018, 16:32
Official
  Dear TTeresa 

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 reply15 Nov 2018, 12:54
Official
 Dear TTeresa 

We have been in touch with you to answer your comments.  Regards
 Discovery Health Servicing Team 
ON
Obakeng N's update15 Nov 2018, 14:09
Reviewer Update
Can someone please explain below mail to me in a simple terms as it doesn't make sense to me . Kindly just advise why the claim was rejected so below mail explains that the claim was rejected because I went to my Listed GP and she referred me to Radiology , that means my keycare plus plan does not cover that ? Thank you for contacting us. Membership: Claim query We have processed the claim you have queried as follows: Mashao and Dzichauya Treatment date Amount claimed (rand) Amount paid (rand) Reason code 6 November 2018 R1 263.99 R0.00 332 Code 332: Your plan does not cover these treatments or tests. You need to pay this amount. Radiology referred by GP On the KeyCare Plus plan, coverage for a formulary of radiology, when referred by the chosen or out of area GP, is provided. The KeyCare radiology network needs to be used you will be liable for the payment. I have included a KeyCare radiology form your convenience. If the radiology is requested during an out-of-network consultation, a limit of 4 radiology claims per year will apply. Radiology claims will be paid at 100% of the Discovery Health Rate. If you have any more questions, please call us on ***, email ********** or visit www.discovery.co.za Regards Devashnee Abid Discovery Health (Pty) Ltd On behalf of Discovery Health Medical Scheme