1 reviews | Active since Apr 2011
Repudiation of Pregnancy claim
I've been on Discovery Medical aid for 7 years, and never claimed. I added my wife on the cover on the 01/11/2014, effective from 01/12/2014. Yesterday I was informed that my wife was 9 weeks pregnant when i added her on the cover, therefore Discovery medical aid scheme wont be covering the delivery of my son, and that all the previously costs paid (Pharmacy and Gynecologist) related to pregnancy will be reversed, therefore rendering me personally liable.<br> <br> My wife is due is 15 days time, and i'm informed of this only now, after Discovery created an impression that pregnancy costs will be covered, by covering previous gynae consultations. Thus far i have paid premiums over R72,000, accompanied by no claim in the past 6 years. This is how loyalty is appreciated. Can someone please advice on steps to follow if i want to query this and have this decision reviewed? I have already submitted an online complaint to The Council of Medical Schemes - SA, and will be seeking an advice from talk 702 listeners today. <div><br></div><div><em>(Supplier name changed from <em>Discovery Vitality &
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there were any pre-existing conditions of which we were not aware.
The Scheme has only now established that there was in fact an established pregnancy at the time of contract commencement, and has merely corrected the underwriting, based on the newly accessed information, available to both you and Discovery Health. The waiting period has only now been app**** correctly. We've also sent you an email outlining the details.
Regards
Arthi
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there were any pre-existing conditions of which we were not aware.
The Scheme has only now established that there was in fact an established pregnancy at the time of contract commencement, and has merely corrected the underwriting, based on the newly accessed information, available to both you and Discovery Health. The waiting period has only now been app**** correctly. We've also sent you an email outlining the details.
Regards
Arthi