TN
Tish N

1 reviews | Active since Feb 2022

01 Jul 2025, 20:37

Unpaid benefit -apparently an incorrect code

I had a HPV cervical test done at my gynecologist's office as part of a Pap smear, and I expected Discovery to cover the lab work according to my benefits.

However, Discovery rejected the claim, stating that the procedure code used does not match that for an HPV Pap smear test.

As a long-standing member of Coastal Core, this is my first time claiming this benefit, and I'm shocked by the lack of clarity and assistance from Discovery after using your online assistants. Despite providing Discovery with the test results, which clearly indicate that HPV results were obtained from the Pap smear, you are still refusing to cover the costs.

I've contacted the doctor's office for assistance, they stated, that either Lancet messed up the procedure code or discovery has incorrectly rejected my claim.

I've reviewed my benefits, and it's stated that Discovery covers HPV tests every 5 years. However, NOWHERE can I find the specific procedure code required to ensure my billing goes through. This code is suspiciously left out of your benefit booklet and only the normal pap smear code is provided .

The lab, Lancet, is now requesting payment of R1300.00 from me, citing that the procedure code used was as per the doctor's request.

I hope we can resolve this issue amicably and efficiently. I look forward to hearing from you soon.

I find it highly suspicious that the procedure codes are left out for this benefit , get you BOLDY claim that it forms part of your prevention program. I hope that someone can help me,I've tried everything. Otherwise I'd will be forced to lodge a complaint with the ombudsman.

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Replies (2)
Discovery Health
Discovery Health's reply02 Jul 2025, 07:08
Official
Dear Tish N

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 reply07 Jul 2025, 17:14
Official
Dear Tish N

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

Regards
Discovery Health Servicing Team