SR
Sanet R

1 reviews | Active since Mar 2018

25 Apr 2024, 12:30

Spinal Care Claim Rejected

I called Discovery Health on the 4th March 2024 to enquire about the Spinal Care Programme. During this call I was informed by the agent that Discovery would refund me the consultation fee. I then made a booking for the 5th March 2024 with the nominated Spinal Care Orthopedic Surgeon, Dr Oosthuizen and paid a R1000 for the consultation. When I submitted the claim and proof of payment, my claim was rejected, as my plan does not cover the service. When I submitted the claim I specifically made a note to say that it was to enrolled on the Spinal Care Programme. The Dr was paid for another claim they submitted when they enrolled me into the programme, but Discovery did not refund me. They are welcome to listen to the recording as that is what I was told, it was very clear. If Discovery approved the programme and paid the Dr and Chiropractor, why did they not refund me.

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Replies (4)
Discovery Health
Discovery Health's reply25 Apr 2024, 12:40
Official
Dear Sanet R

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 reply26 Apr 2024, 16:35
Official
Dear Sanet R

We have been in touch with you to answer your comments.

Regards Discovery Health Servicing Team

SR
Sanet R's update29 Apr 2024, 13:52
Reviewer Update
Colleen contact me today and I was told that the claim date the dr submitted is not the same as the date I had the consultation with the dr and due to this the dr paid. I checked my claims statement and the dr originally submitted a claim for the 5th April, same date I visited the dr and it was rejected by Discovery. Then the dr re-submitted the claim the next day and Discovery paid the dr and they did not refund me as it now seems I visited the dr on 2 different days. Colleen needs to call me back and explain why she said the claim was submitted on the 6th, yet my claims history shows it was indeed submitted for the first time on the 5th, the actual date of service.
Discovery Health
Discovery Health's reply23 Oct 2024, 13:49
Official
Dear Sanet R

We have been in contact with you.

Regards Discovery Health Servicing Team