1 reviews | Active since Jul 2020
Vague Policy Wording.
I had an emergency where I had been taken in for a knee injury. As I am on the Keycare Plus plan, one can only go to a hospital within the network of which the hospital I went to is in a network hospital. As part of treatment, I was provided with crutches and knee brace. Although i accept that they do not cover the knee brace, under the 2025 guide, the scheme says, for medical equipment: On KeyCare Plus, we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R6,050 per family per year. Not covered on the KeyCare Start or KeyCare Start Regional plans.
The hospital and the suppliers of the crutches have reached out to me and said that my claim for the medical equipment was rejected and this is due to the scheme not covering this item.
I enquire with the scheme, and what I have been advised by the consultant is pretty bizarre and this is why I think it’s important for Discovery to be transparent as their policy wording is vague and potentially misleading.
The consultant says the medical equipment is not covered due to it being supp**** by a provider not in their network. The questions is, who are the providers of these equipment and how do clients know about this? They provided a list of 3 suppliers/providers unbeknownst to me or anyone i believe as they don’t have any of this information available on their policy wording or guide.
Now the big question is, if a client is in a network hospital, they provide you the equipment, isn’t that supp**** by the network provider? That is how I understood it provided that the scheme does not clarify these providers so that we know.
Also, if someone is in casualty for a serious injury and needs crutches, how is it that we have to contact and order these crutches and they’re are to be delivered to you at god knows which time, how is that even plausible? Well that’s what the consultant told me, “next time you will contact one of our providers and they will have these equipment delivered to you”.. how when i need them to walk out of the hospital after being discharged?
In summary, the experience with the scheme has been unpleasant and also to highlight their vague wording needs to be address because even the consultant couldn’t point me to where these providers are named, only they know and the clients are left in the dark.
They tell us which hospital, which doctor, which pharmacy is in their network but they don’t tell us who the network provider for their medical equipment is until you are in a serious ditch, then they tell you about the future.
This needs to be addressed.
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
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
After having pointless discussions with Discovery, they advised that i should apply for Prescribed Minimum Benefit so they can review my claim and see if it falls under the PMB.
I have sent my application and all supporting documents, and expectedly, Discovery declined the application due to the ICD -10 code used not falling under PMB. Further to that, my application was just removed from the application tracker, no communication regarding the status of my claim although they recommended that i visit this tracker to check the status but they miraculously removed it without letting me knowing the outcome. I had to call them to ask what happened, and that is when they said it was declined .
Poor customer service is what they strive on.
I have to argue this case with them as it also once again very ********* what Discovery doing.
If you guys tell clients to visit a network hospital, of which i did, the Dr then prescribes crutches as part of treatment, which you guys have said you will cover if issued by the network supplier, is the hospital not a network supplier? how is the client to know who your network supplier is?
I have asked these questions over and over again, but no one at Discovery seems to have a clear answer. They even told me that if i need crutches in the future, i should request them from the network supplier and they will courier them to me…
Sounds ridiculous right? How does someone in a hospital, in an emergency request such equipment and wait for it to be couriered to them when you need to leave the hospital after being discharged? Does not make sense but yes Discovery said that’s how it should be.
Now i have a bill for crutches with the hospital supplier who happens to not be their preferred supplier or a network supplier so they won’t cover those yet if they were from a network supplier they would have paid. The type of crutches provided by the hospital supplier is a similar type they would cover if provided by their network supplier… So why is the network supplier not at the network hospital to provide these medical equipment to clients? Also, who are these supplier? and why does Discovery not make it known who their suppliers are so the clients are aware?
It goes back to the vagueness point. It’s all designed to mislead customers .
So we have reached a deadlock with Discovery and i have resorted to escalate matters to Council for Medical Schemes due to the failure of Discovery to provide necessary care.
Also, if they would have paid for these crutches, the only sensible thing to do is, pay the client what you would have paid the supplier in any case and the client is to pay the supplier who issued this equipment and also probably cover the difference if the amount is above Discovery’s threshold.
So we continue with the mission. We cannot allow such treatment from organisations that take money from us every single month yet fail to provide us the care we need in dire times, especially when they use things like “ not in our network” as a reason for rejecting claims. It is unjust and needs to be addressed immediately.
After having pointless discussions with Discovery, they advised that i should apply for Prescribed Minimum Benefit so they can review my claim and see if it falls under the PMB.
I have sent my application and all supporting documents, and expectedly, Discovery declined the application due to the ICD -10 code used not falling under PMB. Further to that, my application was just removed from the application tracker, no communication regarding the status of my claim although they recommended that i visit this tracker to check the status but they miraculously removed it without letting me knowing the outcome. I had to call them to ask what happened, and that is when they said it was declined .
Poor customer service is what they strive on.
I have to argue this case with them as it also once again very ********* what Discovery doing.
If you guys tell clients to visit a network hospital, of which i did, the Dr then prescribes crutches as part of treatment, which you guys have said you will cover if issued by the network supplier, is the hospital not a network supplier? how is the client to know who your network supplier is?
I have asked these questions over and over again, but no one at Discovery seems to have a clear answer. They even told me that if i need crutches in the future, i should request them from the network supplier and they will courier them to me…
Sounds ridiculous right? How does someone in a hospital, in an emergency request such equipment and wait for it to be couriered to them when you need to leave the hospital after being discharged? Does not make sense but yes Discovery said that’s how it should be.
Now i have a bill for crutches with the hospital supplier who happens to not be their preferred supplier or a network supplier so they won’t cover those yet if they were from a network supplier they would have paid. The type of crutches provided by the hospital supplier is a similar type they would cover if provided by their network supplier… So why is the network supplier not at the network hospital to provide these medical equipment to clients? Also, who are these supplier? and why does Discovery not make it known who their suppliers are so the clients are aware?
It goes back to the vagueness point. It’s all designed to mislead customers .
So we have reached a deadlock with Discovery and i have resorted to escalate matters to Council for Medical Schemes due to the failure of Discovery to provide necessary care.
Also, if they would have paid for these crutches, the only sensible thing to do is, pay the client what you would have paid the supplier in any case and the client is to pay the supplier who issued this equipment and also probably cover the difference if the amount is above Discovery’s threshold.
So we continue with the mission. We cannot allow such treatment from organisations that take money from us every single month yet fail to provide us the care we need in dire times, especially when they use things like “ not in our network” as a reason for rejecting claims. It is unjust and needs to be addressed immediately.
We will be in touch soon.
Regards Discovery Health Servicing Team
We will be in touch soon.
Regards Discovery Health Servicing Team