nN
noma N

1 reviews | Active since Mar 2009

04 Sept 2018, 15:24

Struggling to get claim paid

I've had a nightmare experience getting just one claim to be approved by discovery. I initially submitted a claim on the app. After over a week with no communication from Discovery, I phoned, only to be told that the picture I submitted was not clear enough. So, during that time, no one bothered to call me, and I had to call them.

Then I emailed the claim (seems I sent wrong attachment). Again, whole week goes by, no communication, nothing from Discovery. Again, I call, and then I'm told I attached a wrong document. I ask them why no one bothered to call me, then I'm met with the same tired apologies.

Then I send the correct attachment, more than a week later, I receive a daily claims report, saying no payment, code 857, which says it required ICD -10 code for injury or poisioning. For starters, my son did not have an injury, secondly, he was not poisoned.

Then today I called the call centre, to ask what this code was for. Then I'm told it's to determine the external cause. I explained to the lady that even my doctor told me that he could not determine the cause, and the blood tests and xrays revealed nothing. I asked her why this is the first time I'm hearing of the code being a pre-requisite for payment of a claim. You are welcome to listen to the call for the ridiculous answer, which included that most doctors submit incomplete documents to discovery.

So my point was, if Discovery is aware that doctors never submit complete details, so why not create a checklist for us members (just like Discovery insure does) that will tell us all the information we need to get from our doctors in order to get the claim paid out? I spent over 19 minutes on that call and did not get any assistance at all. A manager was supposed to call me to explain and tell me what's happening, but still nothing. It's been way over a month since I first submitted this claim and I have nothing to show for it. Can someone assist me please!

0
Replies (5)
Discovery Health
Discovery Health's reply04 Sept 2018, 15:50
Official

Dear nmnyn

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 reply06 Sept 2018, 13:20
Official

Dear nmnyn

We’ve just sent you feedback by email. Please contact us if you have any other queries.

Regards
Discovery Health Servicing Team

nN
noma N's update11 Sept 2018, 16:21
Reviewer Update
I did not receive the promised email. Spent a long time on the phone with a lasy who sounded helpful and promised a lot of things, then silence.....no further communication, including a follow up on the promised actions, or even an email address, which she said I could use for any future correspondence on this matter. So it seems I wasted all that time on the phone for nothing. My problem has still not been resolved
Discovery Health
Discovery Health's reply13 Sept 2018, 11:37
Official

Dear nmnyn

We’ve just sent you feedback by email.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply13 Sept 2018, 11:46
Official

Dear nmnyn

We’ve just sent you feedback by email.

Regards
Discovery Health Servicing Team