Discovery Health
Not paying claims or looking at circumstances

My mom had chest pain and I took her to the casualty room. She has a 12 month waiting period for hypertension. An ECG was done; results: normal. Blood test was done; counting's extremely high. After phoning 3 times for pre-authorisation, Discovery Health did not answer. My mom was then admitted. Pre-authorisation couldn't be obtained because of chest pain relating to hypertension and my mom was released before the doctor could establish what was wrong. The physician wrote a letter that she was not admitted nor treated for hypertension and pre-authorisation was still declined. Reason: no final diagnosis. That's just a lame excuse. The total amount of claims added up to R12 500. I even told the corporate health manager that even if Discovery only pays R7000 of the claims, I would be happy. She has a hospital plan, but when she's admitted, they won't even want to pay - because there is not a final diagnosis - that's bull! Why does she then have a medical aid? They pay for so many sponsors, but when their member's need them to pay their claims, they refuse for an unreasonable excuse. That's just not fair. They claim in their logo "the best of care", but they did not care about my mom.

Company: Discovery Health
Country: South Africa
City: Cape Town

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