Unprocessed Claims

In April 2017, my father received a phone call from Discovery Medical Aid, stating that he owes the medical aid R75 000. When I followed up with the medical aid (as I am the one with consent to deal with their medical aid), they stated that it was accounts that were not processed. They said they will reprocess the account and revert feedback back to me. At some stage later on in the year, I followed up again with Discovery, and that account was still not processed. They (Discovery) assured me that they would definitely sort out the problem as soon as they can. Last year July, my mother had a fall and had to be hospitalized. All the doctors charged above medical aid rates. I was explained by Discovery, that if Doctors charge above medical aid rates, the tariff amount would be paid into our account. When I queried, into which account they paid, they said my father’s account. I was informed by Discovery that my parents has about ± R30 000 of unprocessed accounts from 2017. Since July, I have been liaising with Discovery continuously. I have spoken to Melanie Arendse (a Discovery Representative), supervisors, countless agents and we have reference numbers. All the accounts was eventually processed and all the amounts was reversed, all but two service provider’s accounts were not paid from when my mother was hospitalized. On enquiring about the payments, I as well as the service providers was told that the amount was paid into my dad’s account. On speaking to the medical aid about this, we discovered clearly the amount was not paid into the account but was taken by the medical aid against the large outstanding amount that was reprocessed last year. I have been fighting with the medical aid for more than 6 months because the outstanding amount is more than R 6000 for the two services providers. The services providers need their money. My parents are pensioners and cannot afford to pay such a large amount of money. I personally have started paying monthly instalments to these service providers. The one service provider. Sheer Mobility refuse to accept the payments, as they insist that my dad received the money, which he in fact has not receive. Discovery gave authorisation for those 2 services providers to provide the service but now they are not paying. Can you help with this matter please?