JM
Jesswill M

1 reviews | Active since Apr 2011

20 Mar 2018, 04:09

Unfair termination of contact

In November 2017, I rejoined Discovery after having completed a telephonic application, as I always had a very high regard of their medical aid scheme plans. As a classic saver/ Vitality member (monthly fee = R7508) my family and I was encouraged to as much wellness screenings as possible, considering all the benefits. My wife’s most recent screening was a Papsmeer, of which the results indicated that she had an assyst growing on her womb and surgery was reccomended. To our surprise, Discovery declined our request and instead terminated our contract due to the following; “We refer to your application for membership of the Discovery Health Medical Scheme (the Scheme). It appears that when you made the application you did not make full disclosure of your dependent’s medical condition(s). It was a specified term of your application for membership that you must:  Give true, correct and complete information and make full disclosure of your state of health when submitting the application form;  Inform the Scheme immediately if the information that you gave in your application changes. This includes information about your health and the health of those you apply for. The membership application further states that the Scheme may cancel any membership if you and those you apply for:  Do not give us information that later turns out to be relevant to this application.  Give us any information that is not true, correct and complete.  Do not tell us about any relevant changes (including information about your health and the health of those you apply for) between the day you sign the application form and the day cover starts. The obligation to make full disclosure and provide information enables the Scheme to accurately assess the underwriting risk in respect of your membership application. From the medical claims and/or authorisation requests submitted, we have observed that full disclosure of your dependant’s medical condition was not made and we therefore invite you to provide information to refute the analysis below:” What is of high concern to me, is that when I was telephonically contacted by their Risk Reviewer, Jillian Van Reenen, she confessed that it does happen that spouses sometimes unintentionally gives incomplete or incorrect information of their partners. So my question is, why was my wife also not contacted to confirm her medical history seeing that Discovery is aware of the fact that some details maybe be unknown to me as her husband which could have a negative affect on our me membership. (Thank God her surgery was not life threatening). On 1 March 2018, I completed a form to request a copy of my telephonic application recording in order to seek legal advice. I’m still awaiting...instead I received a letter stating that I now owe Discovery money, “According to our records you have ended your Discovery Health Medical Scheme membership. Because of this, you owe an amount of R20055.45 to Discovery Health Medical Scheme. This amount is for claims paid from your Medical Savings Account, or for benefits you claimed for after your membership ended.

When you owe an amount to the medical scheme because you have withdrawn from the scheme, it is called a negative Medical Savings Account balance.”

Today my family and I are left without medical aid and potentially a bad record too...?

0
Replies (6)
Discovery Health
Discovery Health's reply20 Mar 2018, 07:44
Official

Dear jmagerman

We are sorry to hear about your frustrations. We are investigating your case and will get back to you as soon as possible.

Regards
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply26 Mar 2018, 15:00
Official

Dear jmagerman

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


Regards
Discovery Health Servicing Team

JM
Jesswill M's update26 Mar 2018, 16:22
Reviewer Update
I am thankful for the call but I need a solution as I’m still left without medical cover, a copy of my telephonic application and answers to the unintentional undisclosed medical history of my wife. Hope I don’t have to wait another month for feedback.
Discovery Health
Discovery Health's reply28 Mar 2018, 14:43
Official

Dear jmagerman

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


Regards
Discovery Health Servicing Team

JM
Jesswill M's update28 Mar 2018, 15:11
Reviewer Update
Can you please stop posting such misleading replies. Today I’ve received my second call without any hope for a solution regarding my concerns. Instead, it’s requested that I forward all my previous email communications, as if Discovery does not have any trace there of...? I completed and submitted a form to have a audio copy of my telephonic application send to me, instead, almost a month later Discovery is attempting to send me a pdf copy...wow?♂️ My faith and respect for Discovery is quickly deteriorating. Can we please wrap this up now, I have a life beyond Discovery.
Discovery Health
Discovery Health's reply03 Apr 2018, 10:22
Official

Dear jmagerman

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

Regards
Discovery Health Servicing Team