pA
phumeza A

1 reviews | Active since Nov 2014

25 Jan 2022, 15:24

They wont tell you what they wont cover until you have already done the procedure

I would like to issue a complaint regarding discovery medical aid. Policy holder had a spinal cord operation at the net care cuyler hospital on the 3rd November. The pre-authorisation was done with discovery and they sent the first confirmation on the 2nd November and another on the day of the operation, however on the 4th November they sent another email saying they will not be covering the full hospital stay bcz the hospital is not in their spinal cord procedure network hospital. This is information they should have advised on the first pre approval so the account holder can get the opportunity to change the procedures to a different hospital which the insurance would cover fully. However, the policy holder was sent an email on the 4th telling her they will only pay 80% of the stay. Leaving the policyholder with the R31000 bill. I have tried to contact discovery numerous times to dispute however they still maintain the claim is valid.

0
Replies (3)
Discovery Health
Discovery Health's reply26 Jan 2022, 07:15
Official
Dear Phumeza A

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 Jan 2022, 18:28
Official
Dear Phumeza A

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

Regards
Discovery Health Servicing Team

pA
phumeza A's update03 Mar 2022, 10:22
Reviewer Update
Let me say the discovery team, assisted with the above concern and my issue got resolved to my satisfaction.

Discovery needs to know clients do not need to go to such extremes to get assisted.