1 reviews | Active since Feb 2020
Discovery Flexicare – Repeated Assurances, System "Errors", and No Reimbur*****t
I am extremely disappointed with my experience with Discovery Flexicare.
Before taking my 5-week-old infant (diagnosed with RSV) to a paediatric specialist, I phoned Discovery Flexicare twice to confirm whether the specialist could be used. On both occasions, I was clearly advised that:
The specialist was acceptable, I could pay cash, The consultation fee was within my Flexicare Plus limit, I would be reimbursed within 1–3 business days.
Relying on this confirmation, I proceeded and paid the specialist in full.
After submitting my claim, Discovery rejected it, stating the provider was "not part of the network". When I called to query this, I was told it was a known system error and that my claim would be corrected and paid as part of a batch process.
Over the following two weeks, I made multiple calls and received the same assurances, including that the matter had been escalated. Despite this, no payment was made.
The claim history now reflects internal adjustments followed by repeated rejections, suggesting Discovery is aware of an internal processing issue but has failed to resolve it. At one point, the claim summary even reflected R0.00 while the rejection remained.
This situation has caused unnecessary financial strain and stress, particularly given that it involved a sick newborn and upfront payment based on Discovery's own advice.
I am still awaiting reimbur*****t and a proper resolution.
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards
Flexicare Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards
Flexicare Servicing Team
Please check your emails for feedback from us. Regards Flexicare Servicing Team
Please check your emails for feedback from us. Regards Flexicare Servicing Team
As requested by your team, I contacted the doctor to amend the charge codes. A revised invoice was issued using the exact codes suggested by Discovery, and I submitted this immediately.
Despite fully complying with your instructions, the claim was rejected again with the same outcome.
I then contacted your call centre and was advised that this is a "known system error" and that the matter would be escalated. A few days later, I received another rejection notification.
I followed up again via email querying why the claim was rejected after I had comp**** with the coding correction request. Once more, I received the same rejection response.
At this point, it is clear that the issue is not incorrect coding, as I acted on the guidance provided by Discovery and still received the same outcome. This suggests a deeper processing issue that has not been resolved internally.
I appreciate the public response, but I would still like this matter properly resolved. Repeated rejections after following your own instructions cannot be considered an acceptable outcome.
As requested by your team, I contacted the doctor to amend the charge codes. A revised invoice was issued using the exact codes suggested by Discovery, and I submitted this immediately.
Despite fully complying with your instructions, the claim was rejected again with the same outcome.
I then contacted your call centre and was advised that this is a "known system error" and that the matter would be escalated. A few days later, I received another rejection notification.
I followed up again via email querying why the claim was rejected after I had comp**** with the coding correction request. Once more, I received the same rejection response.
At this point, it is clear that the issue is not incorrect coding, as I acted on the guidance provided by Discovery and still received the same outcome. This suggests a deeper processing issue that has not been resolved internally.
I appreciate the public response, but I would still like this matter properly resolved. Repeated rejections after following your own instructions cannot be considered an acceptable outcome.