Wednesday, March 28, 2007

Why they are called "Discovery" Health

I love my medical aid. They are so sweet. They deduct money from my account every month, which technically makes me their customer. But don't expect them to actually treat me like a valued customer. That would be too much to ask, most of the time.
Earlier this month we sent through a claim, complete with the required ICD-10 code. According to the Council for Medical Schemes web site, each line item must contain an ICD 10 code. The invoice we sent contained only one line item, and only one ICD-10 code, written between the line item and the invoice total. The claim was rejected by Discovery Health. Even the rejection reason supplied was incorrect.
It's their modus operandi: if the customer goes against their internal regulations or systems, they don't pay. Then they wait for the customer to phone in to "discover" the reason. That's why they're called "Discovery" Health.
Heaven help you if you complain. I complained to HelloPeter and got phoned by an arrogant little twerp who didn't read the complaint and ignored everything I said so he could trot out the "party line" about how the industry was at fault and of course DH did nothing wrong. Of course.

7 comments:

Anonymous said...

Give them a break! One part of the organisation has no idea what the other part is doing! You honestly can't expect them to keep their customers informed.

Anonymous said...

I am also having big problems with Discovery Health over their HP account. The money in the account ran out last year in June, (this I accepted) so no accounts were paid until end of January this year when I increased the amount. Only to "DISCOVER" that they paid this money to calims for last year even though I had been paying the doctors myself. I have been struggling to get a recon of treatment date and payment date, to find out what happened to the money. I can't wait to move to another medical aid!

Donn Edwards said...

You have to watch every claim and payment carefully. You should be able to pick this up from the web site.

But I would complain to the doctors for not letting you know that they account was being paid twice.

I'm not convinced that any other medical "aid" will treat you any better, but I'd love to be proved wrong.

Anonymous said...

When I signed up with a new company,I had my wifes as a depandant,but crossed her out before faxing that form back to the company I was about to join.On the starting day with this company,I indicated to the HR manager that I want to include my wife as a depandant,that there were possibilities that she was going overseas hence I crossed her out.The Manager agreed but adviced that she will add her the following month as the forms were already gone.Discovery is now saying,because she(my wife)is 5 months pregnant,they wont cover her until the baby is born..Is this fair??

Anonymous said...

Discovery love using technical and admin problems in order to decline payments. They seem to have a never ending list of excuses; afterall they are not there to help people, they are there to make money! If they were really there to provide a service to their clients and to help people then we wouldn't have so many people leaving Discovery on a daily basis!!

My suggestion is that you move medical aids, unfortunatly if there is a maternity confinement involved then the medical aid is allowed to decline payments related to the maternity confinement. Fair hey....

Anonymous said...

Discovery is a sore looser Period... sadly we the members were in the dark for tooo long. I believe there are far much better and simpler medical providers out there.

My story well they robbed me in broad day light... then when it suited them they used their book/protocal on me LOL

FIRSTLY….I WILL NEVER ADVISE ANYONE TO JOIN DISCOVERY HEALTH…THEY HAVE THE WORLDS CLASSIC & MOST PATHETIC SERVICE.

• FEBRUARY REQUEST THAT MY SPOUSE BE THE PRINCIPAL MEMBER, I REMAIN THE OWNER & PAYER

• REQUEST MADE IN APRIL WITH SHABNAM TO DOWN GRADE PLAN & REMOVE VITALITY CONFIRMED WITH SHABNAM

• MSA BALANCE REQUESTED PAYOUT TO BE PAID OUT TO MY CONFIRMED WITH TYRON TO BE MADE ON THE 16 SEPTEMBER 2008

• TWO PAYMENTS NOT MADE AS OF MAY HERMAN CONFIRMS PLAN IS CANCELLED & REQUESTS AN EMAIL BE SENT FOR MSA TO BE PAID OUT EARLIER.

• NEXT MORNING THEY NOT ONLY DOUBLE DEBIT MY ACCOUNT OF THE INITIAL PLAN

• AFTER CONVERSING WITH VARIOUS INCOMPETENT INDIVIDUALS (INDIRECTLY AGREED BY LAURIEN- SEEING THAT SHE SAYS THEY WILL UNDERTAKE TO DEAL WITH THE ABOVE INDIVIDUALS AND THEIR LINE MANAGERS FOR BREECHING CONFIDENTIALITY, PROVIDING ME WITH INFORMATION THEY SHOULD NOT HAVE GIVEN)

• SHE FAILS TO RESOLVE THE PROBLEM AND CREATES A NEW ONE BASED ON THE RUBBLES OF A DESPRATE CORP THAT NEEDS TO COVER A*$E.


2008-07-01 DISCHEALT E3251273 -39698358 6.00 -4,266.00

• YOUR WEBSITE CONFIRMS NO CHANGE TO THE PLAN…

CLASSIC SAVER
Health Plan: R 1,519.00
MSA: R 506.00
Vitality/Keyclub: R 108.00
Total Monthly Contribution: R 2,133.00

• SO NOT ONLY HAVE YOU FAILED TO COMPETENTLY ASSIST ME WITH A REQUEST MADE IN APRIL….
• KEEP YOUR WORD TO CANCEL\
• OVER DEBIT MY ACCOUNT….

• AMUSE ME…LETS SEE IF YOU CAN NOW GET THIS RIGHT

• MEMBER NUMBER 083940410 WAS CANCELLED 01 MAY 2008.

• REFUND CLIENT R 4272 (INCLUDES BANK CHARGE FOR UNAUTHROISED DEBIT)
6.00 -4,266.00
• PAY CLIENT OUT MSA AS SHE CLEARLY IS NEEDS HER FINANCES.
o AND PLEASE FEEL FREE TO CONTACT THE CLIENT… CONTACT DETAILS BELOW!!!
o ADVISE CLIENT ON TURN AROUND TIME/ SLA FOR QUERY TO BE RESOLVED
o CLIENT WOULD LIKE TO KNOW WHO/NAME OF PERSON THAT WILL BHE HANDLING/ NOT ARGUING THIS QUERY

Leon said...

I hear people complaining about Discovery all the time. I have no idea why I joined a medical scheme like Discovery. They really are a bunch of schemers. If it's not their sales consultants lying through their teeth it's their admin people that don't know their but from their nose.

I joined Discovery in the beginning of the year, because my wife and I were doing some family planning and thought it a good idea to be prepare. I registered as the primary and listed my wife as the dependent.

3 months ago I went to my house doctor for a check up and he informed me that I had lepoma and that he could remove it in their operating theater if I'd like. It wasn't life threatening, but was uncomfortable. I asked him the cash price for doing the operation and he asked me if I didn't have a medical aid. I told him I was with Discovery and he suggested that I claim for the procedure from Discovery. I would have paid cash, but the doctor made a valid point. So I contacted Discovery with the procedure details, the practice number and the doctor's practice number.

2 Days went past and someone from Discovery phoned me and said that it was their protocol with new clients to check with the doctor if all is legit with a claim.

2 Days after that a woman from Discovery accounts phoned me and informed me that Discovery was canceling my contract from date of inception due to non disclosure from my side. When I asked her what the reason was she said my doctor informed Discovery that I had the lipoma for a couple of months. This means that I had the lipoma when I filled in the application form and therefor my membership is being canceled. She also informed me that the first moth's premium is forfeit and I will only be refunded some of the rest.

Now, if I was dishonest and knew of the lipoma and what lipoma was before I joined, I wouldn't be writing this post and would accept Discovery's story. Here is what I don't understand:

When I phoned my doctor about this he said he didn't receive any phone calls nor any other correspondence from Discovery regarding my claim and was still waiting to hear from them before he could give me an appointment for the procedure.

I then phoned Discovery and asked them what was going on. I was told that the forms were sent to my doctor already. When I asked who the doctor was they gave me a name of a doctor I don't know and a completely different hospital.

I've been trying to get my money back ever since. The sales consultant that sold us this snake oil keeps promising us that he got Discovery to agree to refund us 100% of our money, but I haven't seen a cent. This morning when my wife phoned the sales consultant he said that Discovery got a letter from my doctor saying that I had the lipoma for 16 years already. This is the same doctor that I don't know.

I am a web designer and I am now in the precess of designing a blog similar to hellcom.co.za

This site will be for the disgruntled Discovery client or ex-client for venting purposes.

I still hope I get my money back, but then again I've always been a wishful thinker...n


Warning: The NSA and 4 million other sick weirdos with "security clearance" have intercepted this page and know that you are reading it.