AM
Angelique M

1 reviews | Active since Oct 2016

07 Oct 2016, 16:37

Taking almost 2MONTHS to claim a co-payment waiver and I'm STILL waiting!!!!!

<p>On the 8th August 2016 in the late afternoon, a dog attacked me at bit me on my face (mainly my lips). I'm on a Delta Saver Plan so I rushed to Bedford Gardens (in Bedfordview) as they are on the list for hospitals for my plan.</p> <p> </p> <p>The doctor at Bedford Gardens told me that I needed a plastic surgeon to stitch me up and that the plastic surgeon at Bedford Gardens was away on leave and would not be back that week. (That Tuesday, 9th August was a public holiday.) The doctor then referred me to another plastic surgeon in Sandton Medi Clinic hospital.</p> <p> </p> <p>Sandton Medi Clinic hospital is not on my list of hospitals but I was told that they would classify it as an emergency since I didnt have a choice. I went in for surgery at Sandton Medi Clinic the next morning (Tuesday 9th August).</p> <p> </p> <p>Once I had recovered a bit, I contacted Discovery Health to waiver the co-payment for going to Sandton Medi Clinic. I explained the story to the lady and she told me to send through a motivational letter from the plastic surgeon. I did and Discovery Health didnt think that that was enough proof to say that it was a emergency. (as if I asked the dog to bite me on a day before a public holiday??)</p> <p> </p> <p>So, I called Discovery Health again and told the same story again and she told me to resend the motivational letter and in addition I included a letter from the doctor at Bedford Gardens, who referred me to the platic surgeon at Sandton Medi Clinic and a statement that I received from the plastic surgeon with the words "Emergency procedures" in the statement.</p> <p> </p> <p>A week later I called Discovery to find out what was taking so long and the lady said that I must resend my email to a different email address and to wait another 3-5 working days. So I did. I received nothing so I called Discovery AGAIN and I was told to send the same email to yet another email address. This was repeated another time. that's right, I sent the EXACT SAME email to 3 different email addresses and had to wait a week each time inbetween.</p> <p>During each call I made to Discovery, I had to retell my whole story each time.</p> <p> </p> <p>My case finally arrived at the Medical Review Team. Last week Wednesday (28th September) I received an email from the review team asking me when had the incident occurred. After telling my story a million times they STILL didnt know that. Anyways, I rep**** to that email on the same day. That Friday (30th September) I called Discovery AGAIN. Retold my story AGAIN. The lady said that I never rep**** to the email on that Wednesday, even though I did! She then told me to send through that email to another email address. AGAIN!</p> <p> </p> <p>I called today (Friday 7th October) just to be told that the lady has no idea when this will be completed and no way to hurry this.</p> <p> </p> <p>During this whole time I never received any automatic replies from Discovery with my reference numbers for the many emails that I have sent.</p> <p> </p> <p>Sandton Medi Clinic is telling me that if Discovery doesnt hurry up then I'll have to pay them and then claim back from Discovery. I can just imagine the horror it would be to try claim back from Discovery when they have been so slow!</p> <p> </p> <p>This has been going on for almost 2 MONTHS! this is pathetic. Everyone around me is horrified with Discovery Health and they tell me to call Discovery Health and DEMAND TO SPEAK TO MANAGEMENT to finally finish with my claim. I have been more than patient and I think Discovery Health is taking advantage of me. I will not pay this co-payment and if after all of this Discovery Health denies waving my co-payment I will sue them.</p> <p> </p> <p>This is a simple claim of waving a co-payment due to an emergency that was out of my control and it is horrible how long they are taking to do such a simple and common waiver!!!!</p> <p> </p> <p> </p> <p> </p> <p> </p>

0
Replies (4)
Discovery Health
Discovery Health's reply10 Oct 2016, 09:00
Official

Dear Angelique_M

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 reply11 Oct 2016, 10:09
Official

Dear Angelique_M

As soon as we’ve resolved and finalised this matter, we’ll confirm by email.

Regards
Cornelius

AM
Angelique M's update12 Oct 2016, 18:28
Reviewer Update

I got an email from Discovery Health stating "This was a voluntary use of a non-desinated service provider. This means that you will remain liable to pay the out of network deductible."

Please explain to me how this was a VOLUNTARY USE OF A NON-DESINATED SERVICE PROVIDER???????

I made a decision based on the options avaiable to me. Discovery cant expect me to stay cut open and bleeding to wait for when the plastic surgeon would come back.

I will be lodging a formal complaint with the Council for Medical Schemes.

Discovery Health
Discovery Health's reply13 Oct 2016, 08:16
Official

Dear Angelique_M

Your concerns are important to us and we will be in touch soon with an answer to your comments.

Regards
Discovery Health Servicing Team