I have submitted 2 claims in the last 6 months with issues on payment and transparency on Scheme rates:
1. Dr Milos dates 2013/12/06: Claim of R1800 with ICD 10 code and And statement clearly showing N93.9 as procedure codes. Now the dr still needs to write a request and report for examination? My dr States he has provided the codes that spesifies the procedure. Why does he have to write an additional report?? Please pay claim.
2. Also Scheme rate shows R441, but my plan should cover 200% of Health care professional rates. Does that mean the rate for a Gynogologist doing my procedure is only R220.50?? That is rediculous. Please provide transparancy of Scheme rate as it was also an in hospital procedure that was done with pre-approval.
3. Dr Z Bierman 2013/7/17: Invoice for Dr is a total of R2925, Discovery paid out R888.05 only. I have tried to get transparancy on the calculation with the call centre but with out any luck. The complaint was logged, and just confirmed to be accurate. Please provide the calculation breakdown to show the application of the 200% cover on the Health Care Professional rate.
Both procedures was In Hospital / Day clinic procudures
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