GM
George M

1 reviews | Active since Mar 2019

16 Apr 2019, 10:30

Unfair rejection of paying Medical Bills by Discovery Medical Aid

Last year 2May2018 my new born son was admitted to Mediclinic in Tzaneen after a suprise illness. The details of the child to be added as my beneficiary to the medical aid were sent to the Discovery consultant at our working site in April. When the child was admitted in Hospital,Discovery then sent all hospital claims for my new born for review. At the end, They used a clause in the medical(non - Disclosure) they rejected all hospital claims under the reason "on disclosure". I followed all internal process to lodge a complain and Disputes within Discovery to proof that the sickness of the child was unknown to me when I first app**** to be added to my medical aid as one of my beneficiaries. But discovery didn't want to take all my facts. The PMA form was sent to a doctor who examined the child when he was already in Hospital, they used that information obtained from the doctor from the hospital to reject all the claims under"non-disclosure".They never wanted to consider information coming from a doctor who saw the child a week ealier before he got seriously sick.But they decided to use the information from the doctor who saw the child at the hospital to create a strong case and rejected to pay all hospital bills for my new born child.Becasue they have all the money to get Big lawyers(my hardworking money that I have been paying to them for 10years at an average of R50 000 -R60 000 per month),they sent my case to their lawyers or specialist to make sure that they defend them against me, to make sure that they don't pay all the hospital and Doctors bills. I have been with Discovery medical aid for more than 10years now and I have paid more than R700 000 to this company with a aim that one day they will cover my beneficiaries and myself during emergency sickness like my new born. But this medical aid is doing all it can to make sure that they will not pay the medical bills for my newborn child. They even went as far as removing the child from the medical aid. Because I don't have the money to pay lawyers like them, let them pay me back some of the money that I paid to them over the course of 10years so that I can pay the Hospital and the Doctors that provided me with an excellent service and saved the life of my child . I cannot be listed on ITC because of outstanding medical bills, but I have been having a medical aid for more than 10years now.

0
Replies (2)
Discovery Health
Discovery Health's reply16 Apr 2019, 10:41
Official
Dear GeorgeMtileni

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

Kind regards
Discovery Health Servicing Team 


Discovery Health
Discovery Health's reply18 Apr 2019, 12:29
Official
Dear GeorgeMtileni

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

Kind regards
Discovery Health Servicing Team