Unprocessed Claims from 2016

Before I start, let me first say that the service I usually receive from Discovery is very good. However, there is one matter that has been going on for over four years now, that both my mother and myself have been trying to resolve with Discovery’s claims department. We keep getting the run-around!

There were two claims for dental/maxillofacial work from towards the end of 2016. My mother submitted both claims well within the four-month claim period, (and we can prove it!), but Discovery never processed these claims.

The first claim was for Dr Van Niekerk, our dentist, and the second was for work done by Dr Karachi, a maxillofacial and oral surgeon.

The claim from Dr Van Niekerk was originally submitted on the 5th of November 2016, reference number: ***. We much later found out that there was a problem with the invoice, the dental laboratory work invoice and codes were not submitted with the original claim, and there was a problem with Dr Van Niekerk’s invoice, in that the date of the dental laboratory work was incorrect and did not match the date on the laboratory invoice. With some backwards and forwards with both Discovery and Dr Van Niekerk’s accounts department, we managed to resolve both problems. We followed instructions from Discovery on both these matters. The amount of this claim was R1816.75.

The other claim was for Dr Karachi. The date of service was the 9th of November 2016, for R1500, and this does not appear on your statement. I first submitted this claim on the 11th of December 2016, and again on the 21st of February 2017. Unfortunately, I did not receive reference numbers for those. We resubmitted it again on the 14th of March 2017, and this time I did receive a reference number for it, ***. The amount of this claim was R1500.00.

For the correspondence for these claims, we have the following reference numbers, among others:

*** – Dr Van Niekerk 24th of December – was advised, “Discovery Health does not pay late claims”. *** - Dr Karachi, 2nd of December 2020 – I sent all the original emails from my account as attachments, and never received a response from Discovery. *** – Dr Karachi and Dr Van Niekerk, before the claims were split up. 9th November 2020. From the mail trail on this one, you can see how long this has been going on!

On Tuesday the 5th of January 2021, I had a call from Reyana Basadien, from the Health Sentiment department, who promised to sort this out for us, and then followed up with an email to which I rep****. That same night, we received two rejection notices from Discovery regarding Dr Van Niekerk’s claim, saying once again that the claim was received too late to be processed! Dr Karachi’s claim wasn’t even mentioned!

Yes, we know that the claims are late! It’s Discovery’s fault, not ours! And we can prove it! Had they processed the claims when originally submitted, we would not now be sitting with this problem!

I ask you, is this acceptable treatment for the claims of a 77-year-old pensioner and widow?