Friday, June 11, 2021

Discovery Medical "Scheme" is not a Medical "Aid"

Whenever I visit my Cardiologist, I remember that he doesn't like medical "aids" because they don't actually help their customers, they are there to collect contributions and keep it for themselves. That's why it is called a Medical Scheme, not a Medical Aid. I always pay him on the spot. Then he stamps the invoice with a "paid" stamp. That's when the fun starts.
To submit the claim and for the MEMBER to be refunded, it has to have a "paid" stamp. You can't write "paid" and sign it. It has to be a stamp. Never mind if the doctor sent you the invoice via email because of the pandemic. Discovery simply won't believe you if you write "paid", it has to be a stamp. And the member has to sign the invoice. No signature, no pay. No stamp, and the doctor gets paid instead of the member. Go figure. Why would a member claim on behalf of the doctor? Oh, because honest doctors hate Discovery. You only find out AFTER the doctor has been paid, and by then it's too late. Screw the customer, when he calls to find out what is going on, just stonewall him and don't tell him why. Tell him to tell the doctor to contact Discovery. After much coaxing, they finally admit that the doctor can waste his time with a call centre, or email
When you send a claim to you are sending a document to a moron. You get an automated message giving you a reference number. That's it. If you follow up with a query, it is ignored. After all, the customer is not to be trusted. Even if he is simply requesting a refund from his own Medical Savings Account, which is, after all, his own money.
Discovery used to be a world-class medical aid, recommended by most medical professionals because they paid promptly, and they didn't get in the way between doctor and patient. They had innovative ideas like subsidising gym membership and rewarding people for looking after their health. Now they are just a medical SCHEME that is only interested in themselves. They deliberately make it difficult for the customer to claim: that's company policy. They try at all costs to avoid responsibility for anything going wrong, and prefer to deflect and deny, blaming the customer if at all possible, and if not, then making unreasonable demands on the doctor.
They are arrogant and inflexible, and no longer think they need to listen to their customers. It will be their downfall. They are worse than the government, and one day the government will take all their money and call it the NIH.

Update: I got a call from Nicole Deveroux, and asked her to follow up with an email. She left out most of what I asked, but sent me the email from Exactly what I expected from Discovery.
Update Tues 15 June: I sent through a R1600 claim for a visit to the Cardiologist. They paid R132.20 from the medical scheme, and R668.40 from my own money (MSA). Not bad since I pay them a piffling R2,241 per month. That means that R799.40 wasn't paid at all. I must just suck it up, even through R581.60 could have been paid to me from my own MSA. They just decided not to, because Discovery knows best how to spend my money. Just like the government.
Update Thurs 22 July: "Chronic" medication costs R527.31 per month. Discovery pays R110 out of their Chronic Benefit; I have to pay R417.31. Now you know why they have a glittering new steel and glass building in the expensive part of Sandton.

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