Yet Again - discovering new ways not to pay

I have been with Discovery for +/- 7 years and personally had not hospital stay.

I had been admitted into Life Bedofrd Garderns end July till August. I was admitted on back pain because the admin use simple English to find codes. Discovery had not approved my admission even though I was in pain and suffering. No one from Discovery had told me that I that my authorization had not been approved. The next day, the poor guy from the hospital had to run around trying to help me. I get had get out of bed, with server back go to the reception and speak to Discovery - all because Discovery could not call me or husband to speak about the hospitalization. Finally I had sorted it out.

Discovery had then put pressure on my attending doctor to discharge - so I was given ****ty treatment from that doctor, despite my cry for help and leg pains that I was experiencing. My new doctor had discovered that I have an autoimmune and a tumor on my leg.

From the time I have been in hospital - Discovery has been authorizing ALL my scans. Now they are refusing to pay, for the hospital stay and scans.

I have spoken to atleast 15 people and each one has a different story. 1) "all your accounts have been settled" 2) "We not paying this" 3) "We are only paying for 6 days" 4) "We are sorry" 5) "Its not problem"

I have heard it all, then because I had been in hospital, I got short paid so my account is in arrears - Discovery just drops money in my account not asking or telling me what it is for. I must call them and beg and plead for an answer. SO I don't have any money to pay out or for my household needs and mainly because of communication from Discovery.

I have had this problem before where Discovery refuses to pay for medical bills - Please advise why you offer Medical aid?

Please advise why is Discovery the "best'"

You can sponsor EVENTS but cannot look after your clients? This is why I am afraid to move everything to Discovery they cause unnecessary stress and debt.

And its not like I am paying R500 for my medical aid!!!! PLEASE SORT YOUR **** OUT!

I would like a detailed report how my claim was handled AGAIN (no one comes back to me) and I would like to see what was paid and what is outstanding, the excuse why you not paying and please do not give me reason codes because it all says then same thing. This is the pathetic response from Discovery (same thing I have been receiving all the time, not very good at problem solving, hey Discovery?)

" I trust all is well with you. I spoke to you on Friday, regarding your Hello Peter post. I have attached the Claims Transaction History (CTH) for each Health Professional that attended to you, while you were in hospital. This will make it easier for you to understand the claims that were submitted and processed for each Health Professional. I queried the short-payment on your claim for Life Bedford Gardens Hospital. Your authorisation was approved for 6 in-hospital days as per the protocol which is in place for your admission type. I have been advised that Discovery Health has paid the hospital claim correctly and that the additional days that the hospital has charged for are regrettably for your own account.

There was a short-payment for the claim received from Krige and Partners, for the MRI of the thoracic spine. As per the authorisation protocol for your admission, scans are limited to 1 per year. The outstanding balance for this claim is for your own account as Discovery Health paid for 1 scan.

As per the notes loaded on your membership, the protocol for your admission was explained.

I sincerely apologise to you for any inconvenience caused."

Pathetic, JUST FYI - I had to pay for the MRI - who pay me back for that? Your Claims Transaction History (CTH) is only legibly to YOU! Not me! I asked for a written report not something that you pull off the system that only you understand.

I am asking for a COMPREHENSIVE REPORT - not what you understand.

WHY WAS I NOT INFORMED BY THE MEDICAL AID THAT THE UPDATED CODES WAS DECLINED? Its doesn't matter who was suppose to update me, the hospital or Discovery - Discovery should have covered their bases to avoid this current situation.

I do not understand what does UNLIMITED HOSPITAL BENEFITS means to discovery.

This is a really ****TY COVER! Only 6 days for back pain??? Realistically is you have back pain, you go for surgery and recovery time is 4 - 6 weeks! THIS DOES NOT EVEN MAKE SENSE.

WHAT IS YOUR SUGGESTION AS A PROBLEM SOLVER???

Cause I am not paying anyone when I pay R4000 for PRIVATE MEDICAL AID and was suppose to be the 'BEST"

SORT THIS **** OUT!!!