Useless service from discovery .

<p>Previous review dated 31 January 2017.</p> <p>I called in 28 November , 02 December ,14 Decmber 2016 I spoke to Novubile , Sihle and another gentleman i wanted to know if i can see a medical practitioner and my psyciatrist i was provided with codes that could claim from as it falls under the cronic bennefit and as per your consultant i have two visits per annum for my psyciatrist and 8 GP none of these codes work i called back and was given an email for ********** i sent the documents NOTHING DONE ! to date I recieved an statement from the psyciatrist today stating that i own them money and that it is 30 days overdue and as for the GP visit i paid cash R978 after i was told by one of your consultant that this would be covered i pay just over R7000 pm on medical aid i think it is time for me to test the market can someone please call me and sort this out or you will force me to cancel my medical aid.</p> <p> </p> <p>I few weeks back i recieved an email from Umiskha requesting the necessary documents and was advised that she will listen to the "calls " and provide feedback</p> <p> </p> <p>HER RESPONSE</p> <p>The investigation was conducted correctly regarding the payment of the claim for 08/12/2016. As per the call on the 02/12/2016, the agent confirmed that treatment codes 0161, 0162, 0163, and 0164 would be covered under the Prescribed Minimum Benefit (PMB) treatment guidelines for the provider N Khamissa.</p> <p>She confirmed that those were the only consultation codes covered from the PMB treatment guidelines.</p> <p>This was the last call prior to the claim, therefore you were advised accordingly prior to the consultation on the 08/12/2016.</p> <p>Disputes Committee</p> <p>Kindly follow the process if you would like to lodge a formal dispute. Please complete and send the attached form to ********** or ********** the scheme will make the necessary arrangements for the Discovery Health Compliance Department to review your case. You should receive a response in 30 days.</p> <p> </p> <p> </p> <p>MY RESPONSE</p> <p>Dear Umiksha<br /> What does PMB mean ? and did any of your consultants bother to explain this PMB to me ,the only thing I know is that I was advised that I was covered and when I called back after the claim was rejected due to the medical savings being depleted I was given an email to send discovery the statement to have the practitioner paid for the claim and judging from your response it clearly shows the lack of service and how you mislead and treat your clients unfairly, what about my R978 paid to Doctor Makena you did not mention anything regarding my money that I can claim back , you are very quick to pass the bucket without doing a proper investigation , and put yourself in the client shoes before making any decisions based on peoples money, if you call a contact center and ask if you are covered for a benefit and i consultant confirms yes what does that mean ? , if he said yes under PMB why are you not paying for this ? Again what does that mean ?</p> <p> </p> <p>I am extreamly upset over this matter as discovery takes over R7000 a month from my account and does not take accountability for their mistakes i feel mislead and the fact that you did not do a proper investigation by listening to all the calls i had and emails i was given to have the claim paid that were rejected , not in one call did anyone say this is what PMB means AND THE CODES am i supose to understand your medical codes meani know i called in and was advised that this is covered and given codes that can be claimed under and when i called back after the practitioner had submitted to the savings instaed of those codes i was given an email to have the claim ajusted at no point did anyone say you are not covered i want my money and as promissed the psyciatrist paid as promised</p> <p> </p> <p> </p> <p> </p> <p> </p>