Netcare
Shoulder Surgery

Case number: 1003399372. Authorisation number: 15169563. Patient: W.R. Scott.
I am on an Executive Packagage with Discovery. I went for a shoulder operation in August 2013 at St. Augustines Hospital. This was a pre-authorised procedure and I was never informed that there are any exclusions or equipment that cannot be used during this procedure. To my surprise, I received an ams advising me that there is an amount of R2, 242.18 outstanding (hospital bill). After investigating this, I was told by the accountant of the hospital (Mary-Anne) that discovery returned this amount on the claim and will not be paying for this as an SOMA-SENSOR was used, which is not part of Discovery's Claim Cover. At no point was I informed that the use of this machine is going to be used nor that it is excluded from Discovery Cover, and that I must pay for this. When I was discharged from hospital, I was advised that there are no outstanding amounts, nor informed that the doctor used equipment that is not covered by medical aid. I am escalating this query to DISCOVERY MEDICAL AID as well as to the CASE MANAGER OF ST AUGUSTINES and would like this charge to be reversed as soon as possible.

Company: Netcare
Country: South Africa
City: DURBAN

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