RN
Roean N
1 reviews | Active since May 2018
23 Jun 2024, 18:51
Stay away
So last week Tuesday you promised to have feedback by end of business Wednesday and you didn't take me seriously i will be handing over the call recording to my lawyer and find out what we can do due to the damage you have caused
Pathetic I am deeply dissapointed in them playing with peoples lives, you convinced my stepson to come over to you while he just managed to sort out his medication with bestmed only to drop him in a really bad way, you promised that his medication would be covered and cystic fibrosis is not a disease you play with now he couldn't get his meds for the past 4 months and now you want to tell him he has to upgrade the plan to get coverage for his disease, if something happens to him you better pray that the call recording doesn't come out where your sales people guaranteed that it will be covered.
So clearly you dont underatand the urgency of the situation i was promised feedback before close of business today and yet there was no calls or mails!!! You like playing with peoples lives each day you are causing more and more irreversable damage
Helpful (0)
Replies (6)0
Replies (6)
Discovery Health's replyOfficial
24 Jun 2024, 07:27Dear Roean N
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's reply24 Jun 2024, 07:27
Official
Dear Roean N
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
RN
Roean N's updateReviewer Update
24 Jun 2024, 13:20So Promised to phone back after 11 and once again its 13:20
RN
Roean N's update24 Jun 2024, 13:20
Reviewer Update
So Promised to phone back after 11 and once again its 13:20
Discovery Health's replyOfficial
27 Jun 2024, 16:02Dear Roean N
Please check your emails for final feedback from us.
Regards
Discovery Health Servicing Team
Discovery Health's reply27 Jun 2024, 16:02
Official
Dear Roean N
Please check your emails for final feedback from us.
Regards
Discovery Health Servicing Team
RN
Roean N's updateReviewer Update
27 Jun 2024, 17:06You can publicly reply explain to me why do you continue to encourage people to join your plan if you cant give a proper answer when they inquire he repeatedly said he has CF and thats why he need medical aid cover, he just got everything in place with Bestmed when he had to cancel you could have told him upfront its not covered, because i went and checked your PMB list and said CF doesn't fall under that plan, yes he had financial strain and everybody would like to save but now his health is deteriorating because he doesn't have enough meds to drink it the way he should so i still blame your sales people for not providing enough info to make a informed decision so you were still in the wrong!
RN
Roean N's update27 Jun 2024, 17:06
Reviewer Update
You can publicly reply explain to me why do you continue to encourage people to join your plan if you cant give a proper answer when they inquire he repeatedly said he has CF and thats why he need medical aid cover, he just got everything in place with Bestmed when he had to cancel you could have told him upfront its not covered, because i went and checked your PMB list and said CF doesn't fall under that plan, yes he had financial strain and everybody would like to save but now his health is deteriorating because he doesn't have enough meds to drink it the way he should so i still blame your sales people for not providing enough info to make a informed decision so you were still in the wrong!
RN
Roean N's updateReviewer Update
27 Jun 2024, 17:06Dear Roean
Reference number: ***
Cover query
We are sorry that it has taken longer than expected to provide feedback on your query.
The Discovery Connect Escalations team has provided the following feedback:
Upon investigation, we can confirm that the main member had informed us of his condition and medication, as well as his financial status.
The chosen health plan was confirmed by the member based on his financial standing.
The agent advised the member that a chronic application must be done and the medication will be covered subject to the approval.
The feedback provided confirms that the advice given to the member was in accordance with his cover preference and requirements.
The funding of the medication will remain as per the plan type.
The Scheme will review and allow plan upgrades during the year-end revision period for the change to be effective 1 January of the following year.
We do acknowledge that this is not the feedback you were hoping for however; we hope this explains the Scheme’s position.
We have a responsibility as a medical aid Scheme to apply consistent and fair funding, so that we are not only able to pay claims now, but also to remain sustainable, long into the future.
Disputes
In circumstances where agreement cannot be reached between the Scheme and a member, there is a process set down in terms of the registered rules of the Discovery Health Medical Scheme for resolution of complaints and/or disputes which is adjudicated by a Disputes Committee.
You are welcome to present your views to this Committee, which comprises external, independent legal and medical professionals. We have attached the relevant form for completion and return as indicated, should you so wish.
The form is also available on the website listed below.
Should the outcome of this process not be to your satisfaction, you are then welcome to approach the regulator, the Council for Medical Schemes. They are contactable on *** and it is their requirement that the disputes process be followed in the first instance.
If you have any more questions, please visit www.discovery.co.za.
Regards
RN
Roean N's update27 Jun 2024, 17:06
Reviewer Update
Dear Roean
Reference number: ***
Cover query
We are sorry that it has taken longer than expected to provide feedback on your query.
The Discovery Connect Escalations team has provided the following feedback:
Upon investigation, we can confirm that the main member had informed us of his condition and medication, as well as his financial status.
The chosen health plan was confirmed by the member based on his financial standing.
The agent advised the member that a chronic application must be done and the medication will be covered subject to the approval.
The feedback provided confirms that the advice given to the member was in accordance with his cover preference and requirements.
The funding of the medication will remain as per the plan type.
The Scheme will review and allow plan upgrades during the year-end revision period for the change to be effective 1 January of the following year.
We do acknowledge that this is not the feedback you were hoping for however; we hope this explains the Scheme’s position.
We have a responsibility as a medical aid Scheme to apply consistent and fair funding, so that we are not only able to pay claims now, but also to remain sustainable, long into the future.
Disputes
In circumstances where agreement cannot be reached between the Scheme and a member, there is a process set down in terms of the registered rules of the Discovery Health Medical Scheme for resolution of complaints and/or disputes which is adjudicated by a Disputes Committee.
You are welcome to present your views to this Committee, which comprises external, independent legal and medical professionals. We have attached the relevant form for completion and return as indicated, should you so wish.
The form is also available on the website listed below.
Should the outcome of this process not be to your satisfaction, you are then welcome to approach the regulator, the Council for Medical Schemes. They are contactable on *** and it is their requirement that the disputes process be followed in the first instance.
If you have any more questions, please visit www.discovery.co.za.
Regards
Discovery Health's replyOfficial
28 Jun 2024, 12:49Dear Roean N
Thank you for engaging with us to clarify the details of your matter and allowing us to reiterate the various channels that are available for further appeal.
Thank you for engaging with us to clarify the details of your matter and allowing us to reiterate the various channels that are available for further appeal.
Regards
Discovery Health Servicing Team
Discovery Health's reply28 Jun 2024, 12:49
Official
Dear Roean N
Thank you for engaging with us to clarify the details of your matter and allowing us to reiterate the various channels that are available for further appeal.
Thank you for engaging with us to clarify the details of your matter and allowing us to reiterate the various channels that are available for further appeal.
Regards
Discovery Health Servicing Team