Discovery Medical Aid

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Category: Business & Finances

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South Africa

Discovery Medical Aid Reviews

elainegaddiel June 24, 2011

Undue Enrichment

I joined Discovery for the second time in April this year (2011) and the first premium of R445.00 was debited from my bank account ahich was to cover me for the month of May 2011. I visited the doctor twice in May and due to a technical error, my plan was cencelled by Discovery. I was told that since I was not entitled to be covered, I would be reimbursed whatever was due to me after the Doctor whom I visited was paid. Discovery then debited my account for a further R890.00 at the end May 2011 after the cover was cancelled. I then received a call from the Doctor telling me that Discovery was refusing to pay them because my cover was cancelled.
It is now already almost the end of June and I still didnt receive any reimbursement of any monies that was taken by Discovery. It is unfair that Discovery should have taken so much of my money and refuses to pay the Doctor's fees which is only R300.00 from what the Doctor tells me.
Discovery was so quick to cancel my medical aid due to a minor mistake but they are sure to take money that do not belong to them.
Imagine doing this to a good few poeple?
Discovery is just getting rich by stealing from the poor.
I wouldlike my money returned to me and if Discovery does not want to pay the Doctor, then they must return the entire amount and I can then pay the Doctor myself.
It is really tough and I chose to take medical aid so that I can have peace of mind in case I need medical care.

Problems with Discovery Health July 26, 2009

Unpaid Medical Bills

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.