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Discovery Medical Aid / unpaid medical bills

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Contact information:
Mrs B. Naidoo
To whom it may concern

My husband had undergone heart bypass surgery on the 8th of april 2009 at st augustines hospital. The surgeon who performed the operation on him was mr m. K. Odayan.
On recovery we were faced with unpaid bills amounting to r25 064, 24 which were not covered by medical aid due to a billing problem they are experiencing with the above surgeon. The doctor had bypassed five arteries. He billed on code 1348 as well as using a modifier code and code 1275. What is not making sense to me is that the medical aid paid for one bypass and did not pay for the other four. How did they expect a surgeon to open my husband up and do one bypass?

However on admission, authorization was given by medical aid but I was not informed of any problems or liabilities I would have had to cover personally. The day before my husband surgery, we asked the surgeon before signing the consent form of any shortfalls that we would be liable for, he mentioned that he charges up to 200% of medical aid rates and we were covered for 200%. However medical had paid full for all codes the surgeon had charged except the 4 grafts. This does not tell me that the surgeon had charged over medical aid rates, so why am I left with this bill of r25064-24. Had discovery health or the surgeon informed me of this problem before the operation, I would have got another surgeon whose billing is in line with discovery to operate on my husband.

Discovery medical aid does not return calls neither do that keep you informed of the progress of your complaint. I am now waiting for four months.

Although I am liable as the member, I will not take responsibility for someone else’s mistake or a simple problem such as billing problem between discovery and the cardiothoracic surgeons board. Please can someone help me, as I am now prepared to go public (To the media) with my problem so that other discovery members are not faced with the similar situation. Time is now of essence.


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A  21st of Oct, 2010 by 
Agree Disagree 0 Votes
I am sitting with legal costs and unpaid bills as a result of discovery not paying mounting to over 10k this is alot as my husband only works for the mine. Now my son is in hospital with 2nd degree infection, he has severe eczema and discovery will not give a authorisation for the hospital and supposidly we are covered 200 percent as well unlimited hospital benefits. what on earth are we paying for. this is a child for goodness sake. Stop paying for lavish cars, accomodation sporting bursaries and what more ever luxuries and start looking after your memebrs.
N  3rd of Jun, 2011 by 
Agree Disagree 0 Votes
discovery mediese fonds is een groot bedrogspul elke maand kry ek n staat van hulle waar hulle vir my se hoeveel ek oor het en hoeveel ek vir tande en voorskrifmedisyne kry nog n bedrog papier jou limiet bestaan uit klein lettertjies wat elke maand by hulle opgemaak word mense bly weg ek het al met hoeveel mense gepraat en van al die mediese fondse is hulle die grootst korupsie maatskappy in die mediese bedryf
A  5th of Sep, 2012 by 
Agree Disagree 0 Votes
Ek sit nou met n probleem, my seuntjie is in vir n operasie my man het hom oor gesit op sy medies, en oor die rede dat ons nie hulle vooraf verwittige het dat hy voorheen n operasie gehad het nie, het hulle ons medies sommer net gekanseleer en ons sit nou met n groot rekening vir die hospitaal wat ons moet betaal, hulle beantwoord nie ons oproepe nie en ons kry geen terug voering van hulle af nie (ongelooflik) waarom het mens n medies!!!

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Customer Care Service
The Point Shopping Centre, 76 Regent Street, Sea Point
Cape Town
South Africa - 8060
+27 86 099 8877
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