Discovery Health
Discovery will not pay for Specialist Visit

I am on the Key Care Plus plan - My GP referred me to a Gynecologist. According to the Call centre (upon my first enquiry) Discovery would pay for this. As stated on the Discovery Health Plan Detail Document: "Screening and Prevention Benefit: if members go for certain preventive screening tests, we will cover the claim. The screening tests include: blood glucose, blood pressure, cholesterol and body mass index at a Discovery Wellness Network provieder. THE BENEFIT ALSO COVERS A MAMMOGRAM, PAP SMEAR, PSA AND HIV SCREENING TESTS...". Further more stated also: "Specialist benefit: Your GP must call us to get a reference number before your consulation with the specialist. YOU ARE COVERED UP TO R 2 300.00 FOR EACH PERSON ON YOUR MEMBERSHIP". Discovery then rejected my claim, I went back to my GP with information as advised from Discovery Supervisor. Again, this was rejected today. Reason: I have to give a more "current reason". I fully understand the fact that specialist visits needs to be screened, but the reasons behind rejecting does not reflect the promise they make, as stated above. As long as they receive my monthly contribution they are happy, but as soon as I need them, they run

Company: Discovery Health
Country: South Africa
City: Gauteng

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