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Discovery Health Medical Aid
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1.4 210 Reviews

Discovery Health Medical Aid Complaints Summary

19 Resolved
191 Unresolved
Our verdict: If considering services from Discovery Health Medical Aid with a critical resolution rate, extra caution is advised. Examine detailed customer feedback to understand the severity and nature of unresolved issues. Be prepared for the possibility of unsatisfactory responses and have contingency plans, including seeking assistance from consumer advocacy groups if necessary.
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Discovery Health Medical Aid reviews & complaints 210

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Newest Discovery Health Medical Aid reviews & complaints

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M
6:52 am EDT

Discovery Health Medical Aid incorrect date captured for claim

i submited a claim on the 30.07.2015 and by the 06.08.2015 discovery has not refunded me the money i paid at the DR, so i decided to phone them and follow up, i was told that my invoice shows a date of 30.01.2015 and the claim was then captured under Jaunary claims meaning they will not pay the claim, i have submitted the invoice and proof of paymnet which they both reflect 30.07.2015, so why would i send them an invoice dated 30.01.2015 with proof of payment dated 30.07.2015? and again why will one submit a January claim in august cause surely it won't be paid as its a late notificatiion... then am told that i must go back to the Dr and ask her to write me another Invoice and they will try fix this, realy

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5:43 am EDT

Discovery Health Medical Aid poor service

Adding a Dependent.
I sent application forms in on 17 June, to date addional dependant still not. Numerous reasons. DISCOVERY DOES NOT CALL YOU TO SAY THERE IS PROBLEM. you must smell that there is problem.
THEN you got told one PROBLEM AT A TIME! So between my partner and i we have made about 12 phone call, We resolved 2 issues, 1 which was outstanding since 2006, which i was NEVER informed of, never mind that they have my current phone number.
I have been promised by 3 call operators, that they would get back to..SURPRISE no call backs.

NOW i have to get my brokers to sign a form...i NEVER HAD A BROKER!

No system in place to have your queries escalated...around and around you get sent.

Needless to say - VERY ANNOYED

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3:45 am EDT
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Discovery Health Medical Aid discovery not paying for specialist visits

I am a discovery keycare member. i pay R4700 a month for me and my family. this is the lowest plan discovery offers their benefits are not bad but limited. i was diagnosed with Graves Disease in January this year by my GP. Keycare offers an annual specialist benefit of R3000 per member. keycare does not have an endocrinologist on their specialist panel but I was given the go ahead via email from people at Discovery to go and see one at Christiaan Barnard Hospital. my GP followed procedure and applied for me to see a specialist. i went for my first specialist visit in March and I had to pay R1400 and claim back from Discovery. I did this and got an email from Discovery advising they will refund R300, I have yet to receive this refund. my second visit to the specialist was in May and I had to pay R700. i was told that Discovery would look into refunding me if I paid a shortfall of R80 that was reflecting on my account. I paid this R80 only to be told that Discovery were not going to refund me any of the monies I have spent. I have to buy medication monthly at a cost of R800 which Discovery does not cover at all. I was then told that the specialist benefit my GP applied for expired on the 22nd of July, after my first visit, but they still did not cover any of my visits. how is this acceptable? yes its the lowest plan? but its still alot of money every month that I have to pay. In march I was admitted in the emergency room for dehydration, I had to pay for the blood tests that was done in the hospital. I also received a bill a week later from the hospital for R500+ that I had to pay due to my medical aid not covering? I honestly cannot understand the point of having medical aid, to pay so much money every month and then not get cover when you need it. why bother having medical aid?

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Nirupa Lawrence
, US
Jan 03, 2021 7:07 am EST

I have the Discovery Key care plus medical aid for my 75 yr old mother. She has been ill for 2 weeks now and finally tested positive for Covid. I’ve paid cash for all the dr consultations and medicine until now... thousands of rands! They pay and cover little if any cost! There’s co payments at their selected hospitals too... don’t forget u will have to drive distances to find one. This is the most useless medical aid ever. What’s the purpose of it if u cannot use it? Total rip off. I will cancel it as soon as mum feels better! Don’t waste ur time with them!

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4:51 am EDT
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Discovery Health Medical Aid disgusting service

Since i joined this medical aid it has been nothing but problems. Firstly it was an ongoing back and forth situation to simply add my daughter as a dependent. I had to repeatedly call and email with regards to my daughter being added, when i eventually did get through to someone i was told that the forms could not be processed due to missing information (could they not have called or emailed to let me know, after 3 weeks) Had i not contacted them i would probably still be waiting. Then it was an issue of the forms being sent back and forth, with them asking for more info or to sign every single page.

Then after a few months i realized that i was being overcharged on my monthly bill. Then there was a dispute as to the date of activation for my daughter. I had been given 3 different dates. Once i received my updated card with my daughter already being added as a dependent i took her to my GP, only to find out afterwards that she had not yet been activated.

In March i had been rushed to the hospital with a ruptured appendix and was immediately admitted... Thinking all was well and i am covered as i used one of the Network hospitals. Now i am receiving Claims amounting to over R3 000 with a note attached stating that the claim had exceeded the amount payable.
How do i go to a Network hospital, where i am told that i am fully covered and still come out responsible for paying?
When i try to inquire all i get is attitude and no help. I WAS JUST TOLD THAT I AM RESPONSIBLE TO PAY!

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Nicki56
, ZA
Jun 26, 2015 4:50 am EDT

Good day
I see you have a problem with Discovery Keycare. I'm working at I plan we are medical aid brokers, I'm sure I can help you to get a better medical aid. We are doing a drive to save people money and improve their medical aid benefits. We have products that will give you much better benefits and savings for roughly the same premium or the same benefits for a lesser premium. You can contact me on leroux.nicole2@gmail.com or on sales@iplangroup.co.za so I can give you more details and then we can make an appointment .
Best Regards
Nicole Le Roux.

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5:43 am EDT
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Discovery Health Medical Aid accounts & authorisation

I've had surgery at a Netcare hospital recently in Cape town, which was approved under the Keycare option plan I have at Discovery Health, what happened after the surgery I had it was found that I was diagnosed with TB which I wasn't aware of and needed to go on a treatment plan for the next 6 months, after which the Doctor who was treating me at that stage retired and referred me to a new specialist to continue consultation and follow up until my plan was completed. What bother's me was that no one ever explained that I needed a referral from the current treating doctor to then new Doctor, and as to me what the sensible thing would be is to transfer my already approved basket for PMB benefits to the new doctor right? Well apparently I now need to go back to my GP, get a new authorisation ref to go to the new referred doctor, and then my take the matter further. At this stage I'm sitting with unpaid bills up to R3000.00 which I'm liable for payment and being harassed on a daily basis to pay as my Medical aid just bluntly said well I needed a new approved ref, which according to me was initially for treating doctor at that stage which unfortunately retired, my Only question now is...How is this my problem now that the Approved doctor retired? after I've paid my medical aid contributions on time every month time after time? I feel like I'm being victimised in this sense. I have logged this query with them several times without any success over the past 4 months, and this is totally stressing me out!

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4:02 am EDT

Discovery Health Medical Aid pathetic services

Discovery health promises the world and excellent service, yet gives you lies and attitude. i had taken out the Keycare option due to financial reasons. 2 weeks ago i had broken my foot, been to the Network facilities registered on discovery, firstly when you get to the hospitals you are treated like dirt because you belong to a low scheme as they refer to it as.
up to now after numerous calls to discovery health and visits to the hospital, i have not yet seen an Orthopedic surgeon, and been given the run around by the medical aid to get a simple authorization number. in this 2 weeks, my foot has still remained swollen, and there is bruising. but i cannot seem to get any help from either the hospital or discovery.

discovery consultants also has the nerve to tell me that, i belong to the keycare option and i should not expect excellent service.

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pearlt
, ZA
Nov 26, 2013 11:34 pm EST

Claim rejected because of incompetant people at discovery and when resubmitting getting given a ref number that belongs to another patient. Kumaren and Rishana useless and do not assist at all. They rob peter to pay paul and don't give a [censored] about patients.

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Daphne2121
, ZA
Jan 06, 2012 11:44 am EST
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Well after 7 months discovery cannot get their billing sorted properly. They just take unauthorised debit orders and i have to fit the bill.

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8:38 am EDT
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Discovery Health Medical Aid non responsive, they listed me on itc when payment has been made to them

Discovery billed me R774.00 for early termination of medical scheme of their Brother company LA Health.. I paid said amount as an agreement with Charlotte Roslind, I paid amount and still got demand letters, after contacting discovery again i spoke to Mr. Amir K who said he would look into my case as he sees no payment at all.. I have since not heard anything from the medical aid, I have been listed by this company and it is affecting my credit score.. I have proof of payment which I provided Mr. Amir with, I have been holding to speak with someone who can help me for over 30 mins now, am still holding whilst typing out this complaint. Please take me off ITC whilst you are investigating this.

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I paid the account

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Nicki56
, ZA
Jun 26, 2015 5:01 am EDT

Good day
I'm working for I plan we are medical aid brokers.
I see you have a problem with your medical aid, I'm sure I can help you. We have products that will give you much better benefits and savings for roughly the same premium or the same benefits for lesser premium. We are busy with a drive to save people money and improve their medical aid benefits. You can contact me anytime on this email leroux.nicole2@gmail.com and ill give you more details about. Hope to hear from you soon.
Best Regards
Nicole Le Roux

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8:36 am EST

Discovery Health Medical Aid human rights violation

Good day,

I'd like to start off by explaining my personal situation. I am a single mother of a 4 year old son. I stay with my parents as i cannot afford to live alone. My son’s father does not pay maintenance on my son. Understandably I do not have the funds to pay excessive amount due to medical aids being incompetent.

Firstly I would like to draw your attention to an instance in June/July 2014. I was placed on a waiting period for chronic conditional bipolar disorder. During this period I paid all my medicine out of pocket. Being an acute sufferer of depression I had a nervous melt down due to ongoing financial pressure. I tried committing suicide and was admitted to Palm Tree Clinic in Cape Town. Discovery refused to authorize the hospitalization as I was on a waiting period. The treating psychiatrist (Dr K Moodliar) made various attempts to stress that I needed the treatment urgently and explained the severity of my condition. I was 2 months away from being off my waiting period still Discovery refused and offered not alternative or help regarding my treatment. Consequently I paid the entire two week stay, medicine and doctors’ bills out of pocket. I am still paying back these bills after I went into a payment arrangement with the various suppliers. These bills together will probably amount to well over R 30 000.00

On the 2nd of December 2014 after having waited a year and paying all medication out of pocket I sent through me chronic application for Bipolar. After various telecoms to Discovery I was informed that they would only cover a slight portion of medication needed. I take Aspen Trazadone 100mg nocte and Venlor 300mg in the morning. My first application was rejected as the doctor did not include epitec into her treatment base. My second application was approved for Trazadone but not for Venlor as they are apparently both an anti-depressant. I tried to explain to Discovery that I understand their formulary lists but combing all patients under the same rule seems somewhat unfair. My medication is over R 1200.00 per month. This may seem like a small amount but taking that, together with the fact that i pay full medical aid and I am a single mom... The explanation was given that Discovery does not pay for Serotonin–or epinephrine reuptake inhibitors which would therefore mean that all patients suffering from Bipolar Disorder have to be on the same medicine even though it has no effect on their emotional wellbeing. I have had depression for numerous years and psychiatrists have tried various combinations of medication but I never relieved the symptoms. When they however found the combination that improves my emotional state Discovery was not willing to review full payment of these medicines. I therefore still pay my chronic medication out of pocket and this has, in the last 14 months costed me a minimum of R 20 000.00 already. The doctors have now put my on sleeping tablets as well but i dread sending this application through as I know that they will have an excuse not to pay this too.

On the 9th of February 2015 I Contacted discovery regarding authorization for spinal surgery. As per the specialists notes on the MRI and X-rays there is a severe instability on levels C5+C6. An authorization number was given but I was informed of a co-payment to the hospital of R 11 550.00. I do not think they fully realize the severity of this situation. I contacted them various times on the 10th of February 2015 to get clarity and to request if they would not please review. Again, they offered no solution to the problem. I switched over to a higher plan as to ensure we (my son and I) have more comprehensive cover should we need it. I told them over the phone that i was not aware of the fact that there would be such a large co-payment on spinal surgery as i would not have moved over to that plan if I knew. I broke my neck in a vehicle accident eight years ago and have a fusion on levels C4+C5. I therefore thought that i needed good cover for spinal should something go wrong at some stage. I would therefore not have made the decision to move over to this plan type considering the injuries sustained. As per Discoveries explanation, they are not financial advisers which I understand but surely they should inform members of the pros and cons of moving to different plans. I am now in a predicament as the doctor explained this is very urgent surgery (as he classified this as severe instability) but do not have the funds to pay for this. I have had to cancel my operation and am now running the risk that should I sustain any neck injury, I will be paralyzed.

I wish to draw your attention to the Bill of Rights of South Africa.
Section 11 states: "Every person has the right to life" - the full meaning of the word life is: "the condition that distinguishes animals and plants from inorganic matter, including the capacity for growth, reproduction, functional activity, and continual change preceding death."
a) Refusing to cover my entire hospitalizations for my neck is taking away my right to functional activity as I am restricted in my personal and professional life due to the fact that I do not have access to the full use of my neck.
b) Refusal to pay my admission for bipolar when it was a clear medical emergency as per section 27.3 of the constitutional act almost cost me my life.

Section 12.2.B&C "(2) Everyone has the right to bodily and psychological integrity, which includes the right-
(b) to security in and control over their body;
- Placing patients under a formulary law that states/indicated all patients with a certain condition need to take certain medicine is taking away the patients control over their own body
- Refusing to fully pay my hospital admission for my neck fusion will eventually cause me to lose control over my body as my neck's condition degenerates daily. Should I sustain an injury at this point the chances of losing function of the rest of my body are 99.9%.
And
(c) Not to be subjected to medical or scientific experiments without their informed consent."
- By refusal to cover chronic condition medication in full, I am being subjected to their experiments as I am forced to take medication in their formulary lists of pay my medication out of pocket which I can truly not afford.

Certain professionals in our country have a responsibility to aid in the bettering of the nation’s health. Discovery Health has however not just on one occasion put my life at risk with their absolute nonchalant attitude towards their clients. Being a health and safety practitioner (in construction) myself, I know that when people's lives are stake, you need to go the extra mile to ensure they are safe and healthy. I also know that you cannot treat people in a way that could cause harm or injury as per the OHS act. Compassion is key in this industry and without this you merely function as an organization that is out for people's money. Further to that they have not only placed me at risk numerous times but have over and above what I can afford made sure that they are covered as not to pay claims. I feel exploited and they have gone beyond all means to ensure I do not receive the medical care i need.

There has been an irreparable breakdown in relationship between myself and Discovery Health. I have lost all trust and belief that they are able to provide in my healthcare needs and that they have my sons and my health as a priority.

Could you please provide guidance on how this matter can be resolved as I cannot allow this any further?

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3:55 am EST

Discovery Health Medical Aid incorrect authorisation

When I was booked in for delivery in November 2013, the hospital/discovery had an incorrect authorisation code ( due to a system error ) and by the time they needed to correct the error the self-payment gap was already closed and now I become responsible for the R700.

So if I understand correctly I now have to take responsibility for your system errors? I’m not sure I signed up for that one… When I booked for delivery my understanding is that everything that is done in hospital will fall under my hospital plan ( where does the self-payment gap come in – I’m not consulting a specialist, gp or rendering any service that requires anything to do with my medical savings)

This is not fair seriously not fair

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3:03 pm EDT
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Discovery Health Medical Aid inefficiencies

I assisted my dad to get onto a medical aid. So we contacted discovery. It was an absolute nightmare to get him approved as we had to keep on sending the forms back and forth for 'new' information they needed because he is 60 and has not been on a medical aid for 25 years. Then he gets an ear infection and then they delay the authorization because they say 'they need a full report from the doctor because he recently just joined. This was mid august. The question I ask is why would he have kept the middle ear infection for two months and then only tried to claim for it. It's an infection which is common. Finally the authorization gets sent, he goes to a specialist and then again we must send the forms back and forth for information they need. My dad does not work so he has to keep on going somewhere to have this sent off. My dad also had to pay cash to the specialist for whatever reason. Even though they gave authorization for it! It is shocking! Then you speak to staff who are so rude! Unacceptable

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Nicki56
, ZA
Jun 26, 2015 5:08 am EDT

Good day
I'm working for I Plan we are medical aid brokers.
We are doing a drive to safe people money and improve on their medical aid benefits. We have products that will give your dad better benefits and savings for roughly the same premium or the same benefits for a lesser premium. You can contact me on leroux.nicole2@gmail.com

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3:01 am EDT
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Discovery Health Medical Aid waiting period

Re: Waiting period

Last year december on the day my husbands work closed for holidays, they gave him a permanent contract, that include us going on discovery medical aid at that time we were on medihelp and i was pregnant due in Januarie. we phoned discovery and asked them what we should do go over to them or stay on our medical aid, and discovery advised us to rather stay on medihelp till after baby was born because the would not cover the delivery costs. unfortanately my baby ended up in the NICU and then 3 times after that admitted in hospital until the peads put her on monti- air that is for ashma patients. Medihelp then said we should stay on for six months we suppose it was because of all the hospital costs. long story short we ended our medical aid with medihelp en of june and we were on discovery beginning july they then gave us a waiting period of 3 months each and a 12 month for my baby not to get bronchilitis, any lung infections ect i told them they cant do that they then removed the 12 months but left the 3 months because of my husband and daughter being on chronic medication. that apparently makes them high risk. in all respect i understand that we can have n waiting period were we are not allowed to go to the dr or specialist or do procedures, but my problem comes in when if my daughter gets admitted in hospital coz she is so small with brochilitis or my son or we get in to a car accident they must atleast cover the hopspital after all we are paying them for that service, and all they say is No only if its life threatning.

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10:48 am EDT
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Discovery Health Medical Aid no delivery

I'm really disgusted that the company I work for, forces me to use Discovery health. Over the past 2 and a half years, I've spent upwards of 17 000 on a terrible plan that increases it's price every year, and decreases it's benefits. I have not been to the gp once because it's a nightmare to find a keycare gp close by that doesn't seem to be a sham. I became really ill a a while ago and needed to go to the gp's i'd chosen according to my plan. Except, upon trying to secure an appointment- both gp's phones were not being answered. Infant, upon trying to Google these gp's based on their names and locations, neither yielded any medical practitioner database results. In this day and age, how are gp's not listed anywhere? I phoned discover for help. The first consultant hung up realising these gp's didn't exist. I once again had to pay mt regular gp out of pocket to help me
When I complained on the discover Facebook page, someone got hold of me a few days later and apolagised having tried to contact the gp's. She said that maybe they had moved. Sure
She said she would send me a list with all gp's In my area but never did. I hate discovery. I don't want anything to do with this company.

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12:37 am EDT
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Discovery Health Medical Aid change of banking details

I realised it was 6 months and I have not received my savings claim since I cancelled my membership. I called discovery on the 17th June and they explained that my money was paid to my old account and rejected.I submitted new form and all information required.I called after a day to make sure all documents were correct and the consultant said all is in order and my money would be pain by latest 25th June. On the day i received an sms to say the details were not correct.I was furious as i followed up to confirm.I re submitted the documents again and i still have not heard anyhing.The consultants were friendly but my problem was still not solved and no one has been in contact with me again . The lady who initially helped me went on leave and the guy told me that it was her problem to deal with and i will have to submit the forms again due to other account number
being incorrect.I received the confirmation letter from the bank and the letters are structured so that their are 3 zero's after the account number.Surely you guys have many clients with standard bank and could confirm this with the bank.I am very annoyed as this is taking way to long to solve and has been an inconvenience to me.I would appreciate if someone could sort this out asap. My name is Nadia Gool. membership number is [protected]

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P Reddy
, ZA
Jul 03, 2014 4:28 am EDT

i have had the exact same problem wioth discovery. Apparently I coul
d not receive my refund as the department who captured my banking details has captured this incorrectly, after waiting for onver 45 mins on the line with the co=all centre, Still no one is able to assist.
This makes one wonder how come these mistakes occur so often when refunds are due.

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9:10 am EDT
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Discovery Health Medical Aid hospital authorisation

I am unable to gain hospital authorisation for a DD&C procedure, to be performed tomorrow morning. I have been trying to request authorisation from Discovery since Monday, and they have now informed me, that my hospital and anaesthetist will not be covered. So in fact that are covering nothing! I have been a part of Discover since April 2009, and not once been admitted to hospital or requested any form of procedure. My first procedure, wish is not a happy experience, has been denied and now i either have to cancel it tomorrow, or what? I am so disappointed, over 5 years i have paid them over R150 000 in premiums and still get nothing in return.

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2:02 am EDT
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Discovery Health Medical Aid account department

Discovery Health SA did it again. Suspending the account even if the payment was done and proof was sent to them
This is going on for 1 year now. Every Month the account is Suspended but the money is paid. Then you phone Discovery the (Supervisor) do not want to speak to you as she well aware of the problem and IT IS NOT THE PAYMENT, they will tell you that you are paying into the wrong account, but even if you do payment in 4 different account they will still say it is the wrong account . Sent proof of payment, for what you do not ever look @ it. Discovery is to quick to suspend account but were is the money you paid into there account.

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1:42 am EST
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Discovery Health Medical Aid premium cover

Dear Sir

My family is currently under Discovery Key care for low income earners
This medical aid scheme was taken out by my spouse.
Last year Discovery renewed our 2014 benefits after we provided them with full information ie
-bank statements
-proof of income
-affidavits stating that main member was un-employed at that stage

We than contacted discovery medical aid to verify information and the consultant confirmed
that all was in order. This was done just before we went away for the festive period.
January 2014- Discovery deducted the agreed premiums.
February 2014- discovery deducted double the amount that was paid in January.

I have made several calls and made contact with discovery. Nobody can assist with.

Can you please investigate for me

Regards
Ahmed

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5:13 am EST
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Discovery Health Medical Aid incompetant

Discovery Health SA well yet again you let me down. You failed to supply me with Medication, and then you tell me that I can collect it at Clicks but will have to pay for it but will refund me. Well what if I did not had a credit card or the cash to pay for the medication?

2 months ago I was told by your Manager at your Customer service Desk in Century City that you can’t be held responsible for Opitpharm not delivering as you don’t keep track if they are actually delivering the meds or not and it have been contracted out. I was shock as he basically told me that it’s out of their hands. You apologised then eventually for this mistake, but it was not 30 days later I had to run around calling you and trying to find medication as yet again you failed as a health care supplier. So on the 25 November when I wanted to collect the medication from Dischem I was told I can only do so on the 13 December. That would have been 14 days with no medication. Then after I sent another Email it was brought under my attention that Optifarm (whom we are not even registered with have requested the funds for the Meds) so you say you sorry but NOTHING gets done about this.

Then tell me that I receive Medication and did not pay for it as they put it through on Medical Savings. I know and you know that if they do that the Computer tells them within seconds if it’s been authorised or not. I did not request for them and they were not on me when I left the store. Then you only pay R372.49 of the R1033.96 that is owing to me. You did not ask me if I have taken this medication you just automatically deduct this. I have told you Thapelo Makgatho I have told you that the whole amounts need to be paid as I paid for it all.
I hope the 3 pictures will help you to understand what you owe me and I took you step by step.

Why does Ricky Farber has an email address: [protected]@discovery.co.za but never reply to emails himself. Do they know about these problems in the Company or do they just not care about it.
Nicola Wisbey maybe if you start caring for people you will understand how important this medication is but guess you don’t have to worry as you sitting in a nice office and as your boss get a fat bonus at the end of the year for doing nothing.
Ricky Farber I want to bring this under your attention as I do not think that any of this "mistakes" as Anthony Cooper calls them as no one in his office is held responsible for their actions. Then People like Jaco Thompson who is rude and call you up with the perception and to tell me that I have signed the new terms and Conditions of the Discovery Credit card. Well payment of your card use to have 3 options when I started with Discovery now there is 6 or 8. Then go on to tell me if I pay my bills on Time maybe this would not have happened. I have requested to his Senior Anthony that I would like an apology but still not received this. Only received the T&T the signed copy 2 weeks later after I had to follow up on this yet again.

But at least there is one person Kogi Chetty that took the time out of her day and explained to me more on the Healthy Benefit. Thapelo Makgatho, thank you to you too for your help on getting the tablets every time. Thank you.

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5:04 pm EST
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Discovery Health Medical Aid - claim issues

Discovery insure short paid a claim due to a towing issue. The vehicle however is fitted with the DQ Track system which supplies a customer with the service of Discovery being pro-active and arranging assistance in a serious accident. No service was delivered by Discovery, even claims of the tracking system being removed when the system is still installed...

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Discovery Health Medical Aid claims dispute on hospital discharge date

Discovery membership no: [protected]. My husband was admitted to Unitas hospital on the 11th of July 2013 and discharged on the 13th of July. All accounts were submitted and one particular account for the Anaesthesiologist, Dr. Govind Discovery decided not to pay. First reason that was given is that the Gastroenterologist had to supply the PMA form, which Dr. Reichenberger did in July and then again in September. I had to then resend the documentation through again on the 11th of October as per the call centre agent’s request (ref: [protected]). The PMA documentation was then received and I was promised that the account will be paid. I then followed up again on the 28th of October (ref: [protected]) to check if the payment went through. Again, nothing was processed. This time the reason was given that my husband was not in Hospital on the 13th of July as per Discovery’s record and therefor Dr. Govind’s account will not be paid as Dr. Govind’s invoice date is the 13th. Discovery then claimed that Unitas records show that he was only in hospital till the 12th. I then asked the call centre agent to try and get Unitas to send through whatever it is they need to send through to get the account paid.
On the 1st of November I then again followed up, spoke to Lunga the call centre agent, on ref: [protected] on what the status is of the document they need from Unitas. She promised me that she’ll phone me back and get it sorted as the case has been escalated. I’m still waiting for her call….. I called again the following week and spoke to Rochelle, didn’t get a reference number. At least she called me back and said she’s working on the case with Unitas hospital and added that it’s really difficult for the call centre agents to call the hospital and customers as it’s only an “inbound” call centre and if calls need to be made it needs to be done after hours or during lunch hours? Nevertheless I didn’t get any feedback after that. I called again on the 8th and after spending 45 minutes on the phone and explaining the whole story again to a new call centre agent, he said that he’s spoken to Unitas Hospital and that he’s requested the letter from the case manager, Ntombi, which at the time was not in the office and was to return on Monday the 11th. He said he will give me a call on Monday after he’s followed up with Ntombi and gave me her contact details too, with a hospital case ref ([protected]). To date, I’ve received no call from Discovery and in the mean time I’ve been running around trying to get hold of Unitas Hospital to get this issue resolved.
I called Unitas Hospital this morning, the 13th and spoke to Nomsa, providing her with the case reference: [protected]. She advised that the reference given to me is completely wrong as it was for an admission done in February. That reference was not applicable to Vincent’s admission in July. She then updated me saying that the letter or update of admission was sent to Discovery on the 20th of July already advising that Vincent was discharged from hospital on the 13th pm. See below email from Nomsa. She also advised me that the admission file had already been sent to document storage as they only keep the records there for 3 months and she’ll advise me once the file has been received back from storage.
I’ve spent the past MONTH trying to get an account paid by Discovery, phoning every week, and every week having to retell the whole story to each and every call centre agent I spoke to. This is never mind the fact that the Dr hasn’t been paid as yet and when I log in to see what’s happening with the claim for Dr Govind, it shows as “zero”, and as per the call centre agent it means that it’s been reversed, and no reason was given to me as to why because Discovery is still trying to figure out what’s happening, after 4 MONTHS!.
I find this level of customer service utterly disappointing, having been members of Discovery for over 10 years, this is the kind of service we get?
I expect a person in a managerial position to provide me with constructive feedback on how this matter is going to be resolved and when Dr Govind is going to be paid. I also request that Discovery gives Dr Govind a call to explain as to why the account hasn’t been paid as I’ve been doing all the pleasing and explaining on Discovery’s behalf to the Dr the whole time.

From: Nomsa Motha [mailto:Nomsa.[protected]@netcare.co.za]
Sent: Wednesday, November 13, 2013 8:54 AM
To: Eileen Lombard
Subject: UPDATE THAT WAS SENT IN JULY

Kindly update gen x 2.5

Pt admitted via resus
Gastroscopy and colonoscopy was done
pt have also diarrhea and vomiting
bp 117/74 pulse 75 bg 6.1
meds i.v saline balsol perfalgan gaatriwin ciprobay vsl#3l

pt is discharged 13/07 pm

Nomsa Motha
Case Manager

Netcare Limited
Netcare Holdings T/A Unitas Hospital
Clifton Avenue/PO Box 15123
Lyttelton
0157
+[protected]
+[protected]
: www.netcare.co.za

________________________________________
CONFIDENTIALITY NOTICE: This e-mail may contain confidential information and is intended only for the use of the recipient named above. Should you receive this e-mail in error, please forward it to the intended recipient and delete it from your mail system. Any disclosure, copying, distribution or action on the contents of this e-mail is strictly prohibited. This email and its contents are subject to the disclaimer as displayed at the following link: https://www.netcare.co.za/email-disclaimer.html

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Discovery Health Medical Aid premium breakdown

Spoke to Trevor Richards requested a breakdown of premium paid for one of the depandants since inception I was advised that if one belongs on a group scheme discovery is not allowed to disclose that kind of info I need to speak to my employer. Found that strange as I requested a certificate of membership telephonically (ref # [protected]) and discovery sent it to me and on there my monthly premium is noted (Trevor told me it cannot be sent to me). If I can get my mothly premium from [protected]@dicovery.co.za, surely Discovery should give me the breakdown as well.

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Contact Discovery Health Medical Aid customer service

Phone numbers

+27 115 292 888 +27 315 086 444 More phone numbers

Website

www.discovery.co.za

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