Same as everyone - Failure to pay valid claims...

I was admitted for a procedure a month ago for which I got Pre-Auth and sorted everything out beforehand - no problems. Afterwards, they pay for the hospital costs involved but do not pay for the specialist who did the procedure but instead try to pay it from my MSA. They are suppose to be paying this from my hospital benefit because I WAS ADMITTED TO HOSPITAL.

This isn't the first time either I've been cheated by Discovery Health. A couple months ago I broke my clavicle which constitutes a prescribed minimum benefit (code 902H) which declares that all closed fractures of a bone be covered in full by the medical scheme - Of course Discovery think they are exempt from this (Only way to make money I guess)

For those who don't know, when you start working at Discovery Health (which I have), you are told all about their values and that the over-arching value is that "we exist to make people healthier and to enhance and protect their lives"... It's sad that this sits so shallow with their claims handling teams....

Truly disappointed with this company and wish I could move to another medical scheme, but unfortunately my employer has chosen Discovery as their group insurer...