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EM
Elani M

1 reviews | Active since Mar 2009

03 Aug 2021, 11:11

Round and Round We Go

I received an sms stating that an amount is outstanding for a procedure done in Feb. I then proceeded to contact Discovery Medical Aid to find out why this procedure was not paid in full. Discovery then confirmed that the code that was used was rejected because it was included in the main procedure code. And they confirmed that the rejection shows that I am not responsible for the account. They requested that Lancent should contact Discovery's Health Partners Department in order to resolve the issue. I fowarded this communication to Call Centre at Lancet. The Resolutions Case Administrator then first rep**** that they do not call the Medical Aid on behalf of the members. And this is not the case. After a few back and forth emails the Resoutions Case Administrator then rep**** to say that the medical aid does not cover code 4450 and that the account is still my responsibility. Again I contacted Discovery and they said that the reason why they rejected it, is because it was included in the main procedure and that Lancet needs to contact the Health Partner's Department.

As you can see this will be going on and on and on. I need to have this resolved. And have Lancet contact Discovery's Health Partner's Department to have this matter resolved.

0
Replies (4)
Lancet
Lancet's reply03 Aug 2021, 12:20
Official
Good day, thank you for bringing this to our attention, we have escalated the matter. Your reference number is: 2 5 1 3 1 4 3 . Regards, Lancet Laboratories.       

EM
Elani M's update12 Aug 2021, 15:53
Reviewer Update
Good day,

I am still getting messages from Lancet demanding payment.

Can someone please let me know what the situation is and if something is being done about this?!

Thank you
EM
Elani M's update26 Aug 2021, 15:18
Reviewer Update
Thank you for chatting with us today. Here is a copy of the web transcript. 00:00:19 Lani : The member has accepted the chat. 00:01:08 Leigh : Hi Lani 00:01:21 Lani : Hi Leigh 00:01:30 Leigh : How can I help you today? 00:03:59 Lani : How can I get Lancet to stop sending me messages about a claim that wasn't paid? Discovery is saying that: That code has been rejected because it is included in the main procedure code. The rejection shows that you are not liable for the code. You may advise the provider to amend the code or contact our Health Partners department on ***. 00:04:42 Leigh : The only claim that I can pick up for the pathologist’s is a claim for the 21/02/2021 that wasn’t paid in full. The amount claimed was R2 878.30 and the amount paid was R2 721.80. There's a shortfall of R156.50 due. This claim line rejected as this test was included in the main procedure code billed on the claim. 00:05:39 Leigh : We cannot amended anything on our end with the instruction from Lancet. Lancet will need to contact the Scheme with regards to this claim. 00:06:17 Lani : I have been trying to tell this to Lancet from the start but they keep on saying I have to contact Discovery as they do not contact the medical aids 00:06:28 Leigh : I'm going to email you the transcript of this chat. You can then forward it to them as it will confirm exactly what we've discussed. 00:07:56 Lani : I can actually send you the thread of the last email where I have been trying to tell them this exact words but they keep on sending me statements 00:08:07 Leigh : If they don’t contact medical aids, they surely cannot keep you liable for a shortfall on a claim for a procedure code that’s included in a main procedure code of a claim that they've billed. The medical aid won’t cover the cost for a claim as it will be seen as paying for the same thing twice, which is wrong. 00:08:54 Lani : Exactly! I have even complained on HelloPeter and they have rep**** but never contacted me. 00:09:42 Lani : Could you please send me a transcript of this conversation? If I maybe post this on HelloPeter they might get the picture? 00:09:53 Leigh : Please email them again and attach the transcript of this chat. The only way to resolve this is if they relook at the claim and correct the code or if they contact our Health Partners department for some steer if they are not understanding what the rejection means. 00:10:26 Leigh : I'll only be able to email you a copy of the transcript once our chat has ended. 00:10:46 Lani : Thank you Please see the transcript of the conversation with the Discovery agent.

Please provide me with feedback as soon as possible
EM
Elani M's update31 Aug 2021, 13:58
Reviewer Update
Good day,

I have sent this transcript to your call centre as requested by Discovery, only to receive this feedback from you today:

Good day
Thank you for your email.
Kindly be advised that the billing/tariff codes used are correct therefore the member will remain liable as the medical aid have rejected the test.
If you have any further queries or questions, please feel free to call Lancet's Contact Centre on the ***.
Kind RegardsResolutions Case Administrator

I am so sick and tired of this round and round game that is being played with me. You will be handing me over one of these days and there is nothing I can do about it. Discovery says YOU need to phone them and you say I am liable. So what now??