Discovery Health
Denied claim for approved operation

Hospital arranged authorization on behalf of patient. I was advised by hospital that my OP was approved 2 weeks before going in for the OP. I had the operation done and was told everything was in order.

After this the hospital called me to advise that even though OP was authorized, it was not paid by Med aid. Upon further investigation I discovered that subsequent to the initial auth, claim was denied without informing me beforehand?!!! HAD AUTH BEEN DENIED I WOULD OBVIOUSLY NOT HAVE UNDERGONE THE OPERATION.

mY BR called the PRE_AUTH dept at Disvocery and Jaco Payne advised that the hospital submitted a automatic GRANT CODE. and as such the OP was approved. It was only denied there after. HE asked Jaco why they didn't send me correspondence regarding the rejection and he advised that regardless of the fact it is still my own responsibility to pay this claim.

I find it unacceptable that the OP can be granted at first and then declined without notifying me?!! if someone from my medical aid called me to advise this, i would not have undergone the OP. I HAVE NOT EVEN RECEIVED ANY CORRESPONDENCE REGARDING THIS REJECTION. NO LETTER?!!! NOTHING FROM MED AID. someone sort it out plz!

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

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