1 reviews | Active since Jul 2017
*******
<p>I recently got married and thought it would be a good idea to join my husbands medical aid. Worst decision ever!</p> <p>My son and I become members on 1st June 2017, we are currently in a 3 month period. </p> <p>On the 20th June my sons school phoned and told me that my son (aged 7 years) had severe pain in his mouth, I immediately took him to the dentist where the decision was made for him to have extensive emergency dental treatments with General anesthesia. 3 Abscesses had caused the pain. An abscess is on the list of Prescribed Minimum benefits (code 543C) and any waiting period should not apply!</p> <p>Not to Discovery Health. They are ******* and will do ANYTHING to not provide cover. </p> <p>I would have been in a more understanding position if I was not on a medical aid previously and if this was a planned procedure.</p> <p>Talk about a warm welcome from your Medical Aid Provider! </p>
Dear KHeaney85
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
Dear KHeaney85
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
Dear KHeaney85
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Dear KHeaney85
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Hi Discovery Health Servicing Team
My initial review above still applies. The Doctor provided a detailed motivation letter explaining why the procedure took place, as well as illustrates the abscesses, how can this not be enough?
Hi Discovery Health Servicing Team
My initial review above still applies. The Doctor provided a detailed motivation letter explaining why the procedure took place, as well as illustrates the abscesses, how can this not be enough?
Dear KHeaney85
We have sent you feedback on an email. Please check your inbox.
Regards
Discovery Health Servicing Team
Dear KHeaney85
We have sent you feedback on an email. Please check your inbox.
Regards
Discovery Health Servicing Team
Thanks Discovery Health Servicing Team,
Your email response states the following:
"In order to have a claim paid from the Prescribed Minimum Benefit, certain criteria needs to be met. The following criteria are:
• Emergency admissions (i.e. loss of limb, eyesight, organs or life)
• The procedure codes must fall under one of the 270 conditions, also known as the Diagnostic Treatment Pairs for a Prescribed Minimum Benefit
• The ICD-10 codes must relate to a Prescribed Minimum Benefit condition."
The second bullet point is where my frustration lies. An abscess is on this list, shall I send the 270 Conditions list to you? The motivation letter clearly references the abscesses, in fact, it mentions 4 of them.
Now I am told to dispute the process and obtain legal representation?
Is it just me or is this simple matter not so simple?
#beyondfrustrated
Thanks Discovery Health Servicing Team,
Your email response states the following:
"In order to have a claim paid from the Prescribed Minimum Benefit, certain criteria needs to be met. The following criteria are:
• Emergency admissions (i.e. loss of limb, eyesight, organs or life)
• The procedure codes must fall under one of the 270 conditions, also known as the Diagnostic Treatment Pairs for a Prescribed Minimum Benefit
• The ICD-10 codes must relate to a Prescribed Minimum Benefit condition."
The second bullet point is where my frustration lies. An abscess is on this list, shall I send the 270 Conditions list to you? The motivation letter clearly references the abscesses, in fact, it mentions 4 of them.
Now I am told to dispute the process and obtain legal representation?
Is it just me or is this simple matter not so simple?
#beyondfrustrated