The complaint has been investigated and
resolved to the customer's satisfactionResolved Discovery Medical Aid — unpaid medical bills
resolved to the customer's satisfaction
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.