Discovery Health Medical Aid / misinformed and mislead

South Africa

I have been following up on a claim refund since the 06.03.2019 and after calling in almost every day until yesterday I was told that the money should be released and it wouldn't affect my clawback that I have made an arrangement for.

They lady that initially handled my call ensured me that this claim will be paid out and the money will not go to my clawback, after which I has used money that I needed to pay my bills. I am now in arrears due to the lack of knowledge of the discovery staff.

I was not settled about this and called in the next day and I was told the same, 1 agent I spoke to even told me that the clawback if a different plan and it will not affect my claim and I will be paid out.

I spoke to 6 different people whom all ensured me that the money will be paid via eft, the person I spoke to on Monday told me that if I don't get the money by next day I must call in and they will do a force EFT.

Called back on Tuesday and the guy I spoke to said that it's still within the 5 -7 day turnaround time and that I should call again by today and check if I still don't receive the money in my account.

Each person I spoke to requested me to confirm my account details to ensure the correct banking details are on the system for me to receive payment.

So today I call in and someone decides to do their Job efficiently or correctly ? telling me that I will not be getting paid

I have since spoken to 2 CRMS Michael which I was on the call for 35minutes and Priyan for another 35 minutes who escalated the query to senior management from whom I received an apology that was more of a about being sorry for the staff misinforming me and misleading me.

I was then called by SELWYN CHETTY a senior manager whom keeps on telling me that the staff will be dealt with and that they are new and don't have enough training (how lucky was I to go through untrained new staff every single call I made since my claim was put through) I told him that it is not my problem I honestly don't care as this is about me and he has the audacity to tell me ‘'well everything is about you''. He tells me that ‘'you do know you owe discovery the money ? '' when did I deny that? I have mentioned that from the onset to the staff of discovery upon which I was insured this will not affect anything as I have signed a debit order agreement for the clawback amount to be debited over 12 months which is attached.

Well it is about me right now I have been misled and wronged, due to the incorrect information provided to me by discovery I have utilised money that I knew I would be getting back.

I am now in a financial tuff because of the misinformation which is no problems of discovery ?

It is my consumer right to be Informed and given the facts needed to make an informed choice, to be protected against dishonest or misleading advertising and labelling. The Right to Choose To be able to select from a range of products and services, offered at competitive prices with an assurance of satisfactory quality.

I am totally appalled at the way I am being spoken to and forced to accept what has been done to me.

Very dissatisfied customer.

From: [protected]
Sent: 11 March 2019 11:42 AM
To: Jade Shanker
Cc: Jade Shanker
Subject: FW: Membership No : [protected] -WRefNo#[protected]#- -MailRef#[protected]#-

Dear Ms Shanker
Thank you for contacting us.
Claim for Mauff AC and Partners
We have received your query about the following claim:
Treatment date Amount claimed Amount paid Paid to Reason code Date of payment
2019/02/27 R904.00 R549.60 Member 263, 344 2019/03/07
Reason code 263: We have not paid this amount, as it is outside the scope of our cover. Unfortunately, medical proof doesn't support its effectiveness and long-term outcome. You are responsible for paying this amount.
Reason code 344: We have paid this service at our agreed rates. You do not need to pay this amount.
I have contacted the Account Department at the pathologist to query the reason for the surplus charges.
They have requested a copy of the remittance to be sent to them for further review.
I have emailed the remittance to them for the claim to be reviewed further and await a response from them. Their turnaround time is 5-7 working days.
The account details we have on record for claim reinbursements are as follows:
Name of bank First National Bank
Branch name Remote Banking Service
Branch code 250655
Account type Cheque
Account holder Jade Shanker
Account Number ******0770
If you have any more questions, please call us on [protected], email [protected] or visit
Mohammad Patel
Discovery Health (Pty) Ltd
On behalf of Discovery Health Medical Scheme
FW: Membership No : [protected] -MailRef#[protected]#-
• To: "[protected]"
• Subject: FW: Membership No : [protected] -MailRef#[protected]#-
• From: Jade Shanker
• Date: Wed, 6 Mar 2019 13:41:06 +0200 (CAT)
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• Thread-topic: Membership No : [protected] -MailRef#[protected]#-
Good Day

I was referred to get blood tests done by Br B Bishop (Gynaecologist) on the 26.02.2019, he gave me a lancet form with my Auth number on it to do my bloods.

The gynae said that they only deal with Lancet when I queried as I know there are way cheaper pathologists available, nevertheless I went to lancet at eThekwini heart centre on the 27/02/2019 as I knew that the tests will be paid out from my specialist benefit as I has a specialist referral with an auth number.

When I went to Lancet the lady that saw to me insisted that I pay cash as the system does not take the codes for my key care plan, I tried to explain to her that the specialist benefit will pay out as there is and auth number but she wasnât able to assist me as they do not phone discovery from there offices and if the system said it doesnât cover it doesnât (well too bad for me I have no option)

She told me that I can pay cash and claim from discovery, which I did.

They now have charged me out of discovery rates for the blood tests R226 instead of R183.50

I do not see that this is fair me being charged R42.50 extra per test.

This is R170 extra in total that I need to pay because I was charged out of network rates, I am not sending this mail because I am being petty and I do not expect things for free. I do not expect to be ripped off and charged exorbitantly for tests that should be charged a specific amount.

I would like this matter to be addressed with the mentioned pathologist as soon as possible.


From: [protected]
Sent: 04 March 2019 11:12 AM
To: Jade Shanker
Subject: Membership No : [protected] -MailRef#[protected]#-

Dear Member
Thank you for your email.
This is an automated response to acknowledge receipt of your claim(s). Your request will be processed within 2-3 working days.
Your reference number is [protected], and the details of these claims will reflect on your next claims statement or notification.
Please do not reply to this email.

Jade Shanker
Licensing and Debtors Unit 18 Origin Industrial Park, 14 Riverhorse Close, Riverhorse Valley Business Estate

Tel: +[protected] Ext: 513

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Mar 14, 2019

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