Discovery Health
Non payment of a claim

I had to get authorisation for an examination of the BOTH eyes, under anaesthetic for my daughter. I called in and got an authorisation number. I was quoted R3, 918.00 by the Dr and asked for a pre-assessment to be done, initially they could not do it because the authorisation was captured for 1 eye and had to be updated to state for BOTH eyes. After that was updated I re-sent the pre-assessment and DH confirmed in writing that they would pay R3, 750.00 of the bill. This is now not the case..code 3080 on their systems is for "EYES" and the Dr has invoiced 3080 times 2 (1 for each eye) so to date they have only paid R1, 568.00, after my complaint they paid another R1, 568.00 but have now put my savings into a minus for that amount. The other 3 codes they are trying to force pay from savings but because there are no savings there is no payment. Yesterday I got told that the Dr is charging the codes unlawfully and we should launch a forensic investigation. As far as I am concerned they put in writing what they would pay and if I am not refunded the entire R3, 750.00 I will take this further. I have had enough of DH and their "system" issues. I will be taking this to the Ombudsman

Company: Discovery Health
Country: South Africa
City: Head Office

  <     >