Unprofessional, uninformed Call center personnel & Just plan dreadful levels of service.

After 3 months we still have no resolution. Please provide someone with an understanding and commonsense to resolve. Or a capable case manager !!!

CRNMSR53 I,,1 EDISt1l]TCH CI,AIM HISTORY
Result 99 : 12 r*llhole Claim Rejected** : Rewrite:
Palient : 152920/ 3 PIINIAR R RENE 08/03/2000
l,ledical Aid: R0CI1EDISCK 047030?00 /03 Scripl : ***i E/C1m:30/0?/19 Claimed: 30/0il19 0l:11
l'ledissitch : *** iANv0d Attune: N
***AC C0MB0 SYSIEM 1.000 *,REJECTED ** 2',16.9 30.00/Day
REJECI :258 FREOUENCY AIIOIIIED IOR CODI EXCEEDED.
CLAIMED: 24629,81 - lvl/Aid: 0.00 = Pat:24629,81 {l,vy:24629.81 )
CIAII.IED I RESPONSI IDIEFERXNCE I SCRIPT
r,EW : 49259.62 1 49259,62- I R24629.81
M/AID :24629.81, I I 24629.81 I R0.00
* End of Reporl: MIDIP0ST ,

CRNMSR53 I,,1 EDISIiITCH CI,AIM HISTORY
Result 99 : 12 **llhole Claim Rejected : Rewrite:
Palienl : 152920/ 3 PIENIAR R RENE 08/03/2000
l,ledical Aid: R0CIIEDISCK 047030?00 /03 Scripl : ***i E/c1m:30/0?/19 Claimed: 30/0il19 0l:11
Medissitch : *** ?ANvOd Attune: N
I *** AC C0MB0 SYSTEI,{ 1,000 *'REJECTED ** 7,16.9 30.00/Day
REJECT :258 FREoUENCY Allol,llD IOR CODI EXCEEDED.
CLAIMED: 24629.81 - lvl/Aid: 0.00 = Pat:24629,81 {l,vy:24629.81 )
CIAII.IED I RESPONSI IDIEFERXNCE I SCRIPT
LE!ry : 49259.62 1 49259,62- I R24629.81
M/AID :24629,81, I I 24629.81 I R0.00
* End of Reporl: MEDIPoSI

I trust the issue will be rapidly resolved. Interesting why Discovery is now asking when the original Roche pump was procured (did Discovery not supply the approvals). Has Discovery possibly lost systems data?

To whom it may concern,

1.My daughter was diagnosed with Diabetes Mellitus Type 1 16 years ago. She has been using an insulin pump for the last 14 years.

2.In January this year she started using a Medtronic pump and the claim was processed and approved by Discovery.

3. The Medtronics pump was not compatible with her and she decided that she would rather go back to her AccuCheck Roche pump. Her Roche pump is now four years old and it must be replaced.

4. Metronics credited Medipost on 9 May 2019 and I confirmed with Medipost that they did credit Discovery for the Medtronics pump that was returned.

5. On 5 July 2019 I received a mail from Discovery, mail ***# to inform us that a negative amount of -R37 232,57 was created on our profile. I also received a mail to confirm that the claim was reversed on 30/07/2019 again.

6. I had a telephonic conversation with a gentleman from Discovery who informed me that the claim was reversed and that the funds was available and that the claim would be successfully processed. I asked him at the closing of the conversation if he was sure, he rep**** he was definitely sure and gave me a reference to confirm approval of this ***.

7. Medipost tried to claim a new AccuCheck pump but was informed by Discovery that the claim was rejected – reason code 258 Frequency allowed for code exceeded. Enquiries made by Roche revealed that the code 258 must be reversed by Discovery.

8. On 30/07/2019 I received a call from an employee of Discovery. The lady was very helpful and wanted to assist me with this matter. She informed me that she will call me again with further information by latest Friday 02/08/2019.

8. On 31/07/2019 I received a mail from Discovery to inform me that the finance part of the claim was reversed. I do not contest this matter as I am aware that it has been done on 30/05/2019.

I have to say, it is difficult for me to run into a brick wall with Discovery every time, as it appears as if some of the staff at Discovery cannot comprehend that my daughter has been on the same pump now since April 2015 and that she is due for a new insulin pump. The funds are available in our savings account and Discovery rules are that patients are liable for a new pump every four years.

We have been on the Classic Comprehensive Plan for more that 10 years, not missing one expensive monthly payment during this time.

My hope is on the one employee at Discovery to assist in the process to have the code 258 reversed. If she is successful, I WOULD BE VERY GRATEFUL!!!