Discovery Health used to be great, now I’m starting to wonder

I don’t think I’m alone by saying this, and feel free to correct me if I am wrong, but Discovery Health seem to have gone from a wonderful health cover provider to a nightmare of note.

 

A recent hospital procedure has turned into a fiasco regarding payment from them.

 

Pre-Op

I received 3 procedure codes from a Surgeon, and dutifully phoned Discovery for the Rand Value of what they would cover. This conversation outlined that I would have a shortfall, but I could deal with that, after all I had no choice.

 

Post Op

Surgeons bill received and submitted. Of the three codes that Discovery had originally quoted me on, 1 they now refused to pay, saying the code was a duplicate of one of the other codes, and the other 2 they only paid a fraction of what they said they would pay. In short I have been left with a huge shortfall.

 

During the struggle to sort this out, it has become apparent that Discovery call centre staff are:

 

a)       not trained to understand what the medical codes are for they are quoting on

b)       have no idea if and when codes are defunct, duplicates or whatever, even when they know the code is linked to specific surgical procedure.

 

Also, apparently, pre-op you can email your codes to Discovery who will then provide you with an email quote which is supposed to be more accurate. As I pointed out to them, well it would have been nice if you advertised this somewhere, and or got your call centre staff to suggest this to me before the op.

 

Outcome…so far!

I tried to sort this out via the call centre, but as this was a waste of time, I submitted a complaint via Hello Peter. Within an hour, Discovery called and allocated an Executive Relationship Manager to sort out my query – was this helpful, actually no…

 

Code 1 – the nil payment one – Surgeon had to provide written confirmation of what he had done. This was submitted to a separate society, and still Discovery ultimately did not pay, still maintaining it was a duplicate, and not able to explain why they had quoted me on it originally. Generously for me, my Surgeon has discounted this code/procedure completely from my account.

 

Code 2 and 3 – still in dispute with Discovery. During this part of my dispute, my Executive Relationhsip Manager has been on leave twice and either on leave again or avoiding me. Either way I’m not getting anything sorted. I have no phone number to call him on as these are conveniently not included in rare email communication from him.

 

In essence, it would appear I can email my supa-dupa – tongue firmly in cheek – Discovery Executive Relationship Manager infinitum, and he in turn will infinitum continue to ignore me or enjoy cocktails on a beach somewhere in the Pacific. Some bloody help he is.

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