YJ
Yolanda J

1 reviews | Active since Jul 2014

13 Jul 2015, 17:01

Waiting period

On 17 March 2015,I was admitted to hospital severe abdominal pain, it was an emergency.After several days in hospital,the surgeon requested additional help of a Specialist Physician Dr Bisram a Psychiatrist Dr Miles and a Physiothe****** Mauro Gennari.I had a waiting period of 12 months on several conditions bipolar disorder being one of them.The waiting period lifted on 1 April 2015, 13 days after my hospitalisation.I had an authorisation number from DH and most of the bills and hospital bills were either covered a partially.Dr Miles and Mauro Gennari was not paid due to the waiting period, a difference of 9 to10 days before it lifted.I addressed the ex-gratia committee to review my case, but i was given the run-around, a consultant contacted me and assured me that she will state my case correctly. 4 month's later and the committee sent a reply declining the doctor's accounts on 10 July.I am extremely dissatisfied with the client service I received from DH and my appeal to have the waiting period lifted earlier by10 days for the most.I have been paying my premiums for 11 1/2 months and DH just refused to assist.This was not a scheduled hospital stay,but an emergency,no control.

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Replies (1)
Discovery Health
Discovery Health's reply14 Jul 2015, 14:57
Official
Hello YolandaJogibhai,

Thank you for your comment.

Underwriting is a risk management tool that assists medical schemes in maintaining their long-term sustainability and for this reason we may place waiting periods to help manage the risk.

Following my call to you I trust that you understand the reasons why your claims relating to your waiting period was not funded for by the Scheme and the reason why the Scheme is unable to lift a waiting period earlier than its expiry date.

Regards
Meryl