Discovery Health are dodgy sharks

[FatBoySlim]

Next time Discovery sends you back your bill for an anaesthetist and say unpaid, resubmit until they pay. Im not sure how many people take this as a non claimable item, ive done it twice and each time they have paid no questions asked.
Its simply a matter of them chancing it and hoping you go away. These guys are prob one of the more dodgy companies, right up there with Telkom.

Sent from my Samsung Galaxy Tab

[Roadrunner]

WTF is an anaethetist?

[joepanda]

Something similiar:

Recently got an anesthetist bill, which Discovery paid half of. Sent the anesthetist a letter asking why they charge 200% of medical aid rates and the next thing I know they have written off what I owe them. Moral of the story, anesthetists are dodgy sharks too and sending them a letter calling them on it may just save you a few thousand rand.

[Venomous]

WTF is an anaethetist?

[FatBoySlim]

Hating Galaxy Tab with no proper spell check, just annoying T9

[FatBoySlim]

The point im trying to make, dont be fooled by them, Ive missed out on a good few thousand rands

[Space_Cowboy]

Very good information thanks guys, I was in hospital a 2 weeks ago and the bills are starting to come in also on Discovery.

Funny thing when I went for post OP checkup the Surgeon told me that they can go to 300% where as discovery covers only 146% (Essential Saver) Delta plans it can go up to 200% coverage.

I'm also not very happy with this since they want to see where they can make $$$$

Also saw a bill coming in for R4235 where disovery only covered R3100 so R1135 i need to cover, however the rest of the bills from the exact same doctor was 100% covered so what I am trying to understand is did they " try to get more"

Please post more of these dodgy experiences and outcomes..

Cheers
J

[psichron]

The OP seems to have a valid complaint, but the rest of you really should learn to read you contracts. Depending on your medical scheme, your medical insurance company covers between 100% and 300% of the National Health Reference Price List (NHRPL).
The NHRPL is the recommended price a doctor or specialist should ask for his services.

If a doctor or specialist is considered really good, he/she may ask up to 400% of the NHRPL. You should always confirm beforehand what the doctors will charge you. One simple way to mitigate the uncovered % is to get gap cover. This typically costs about R100 p/m and there are hundreds of gap cover providers in South Africa that covers the last portion of your bill not covered by your medical insurance. The downside of gap cover is that it is not considered medical insurance so it is not tax deductible.

Honestly, if you didn't know what I just said, either your agent screwed up or you just plain didn't pay attention to the stuff you signed.

[Plasticmonkey]

The OP seems to have a valid complaint, but the rest of you really should learn to read you contracts. Depending on your medical scheme, your medical insurance company covers between 100% and 300% of the National Health Reference Price List (NHRPL).
The NHRPL is the recommended price a doctor or specialist should ask for his services.

If a doctor or specialist is considered really good, he/she may ask up to 400% of the NHRPL. You should always confirm beforehand what the doctors will charge you. One simple way to mitigate the uncovered % is to get gap cover. This typically costs about R100 p/m and there are hundreds of gap cover providers in South Africa that covers the last portion of your bill not covered by your medical insurance. The downside of gap cover is that it is not considered medical insurance so it is not tax deductible.

Honestly, if you didn't know what I just said, either your agent screwed up or you just plain didn't pay attention to the stuff you signed.

Amen to that. Its like people taking out 3rd party insurance on their car and expecting the insurer to pay for damages to their car once they in a accident.

There is a very good reason for different medical aid packages. READ the benefits. make sure you know what percentage of the NHRPL your doctor/specialist charges BEFORE you make an appointment. Dont blame the medical aid for being "dodgy" because you dont understand the benefits connected to your spesific plan.

[Garyvdh]

Discovery will pay ANYTHING if you ask them to pay for it... even over the counter medicine.
As long as you realise that it all comes out of your Medical Allowance Account.
If you go to a doctor that charges 5 times the normal rate, they will only pay the normal rate.
But if you ask them to they will pay the full amount. They don't mind paying, they are just trying to protect your medical saving fund.
I suspect that in this case they did not initially pay the anesthetist because he was most likely charging you 3 times the normal rate.
But when you re-submitted the account they paid it assuming you had given them instruction to do so.
It just means that you deplete your Medical Saving Fund faster and hit your self-payment gap quicker.

[FatBoySlim]

"they are just trying to protect your medical saving fund" - lol, yep they certainly are, in which case this means earning less interest for them on my savings which they hold. The point I am trying to make is the fact that they ignore the invoice when I submit the first time, and then take it up the second time, no questions asked. I have done this 3 times now and same thing, so its not just a matter of my invoice landing on the wrong desk, very odd how it always appears to be the anaesthetist bill, very odd as well that the HR dept in our organisation gave me a heads up to this trick which appears to be happening to people other than myself.

Discovery will pay ANYTHING if you ask them to pay for it... even over the counter medicine.
As long as you realise that it all comes out of your Medical Allowance Account.
If you go to a doctor that charges 5 times the normal rate, they will only pay the normal rate.
But if you ask them to they will pay the full amount. They don't mind paying, they are just trying to protect your medical saving fund.
I suspect that in this case they did not initially pay the anesthetist because he was most likely charging you 3 times the normal rate.
But when you re-submitted the account they paid it assuming you had given them instruction to do so.
It just means that you deplete your Medical Saving Fund faster and hit your self-payment gap quicker.

[Garyvdh]

The reason that the ignore it the first time is that they expect you to pay the doctor directly and they will then refund you once you have paid.
This is now common industry procedure. The days of them paying the doctor directly are rapidly diminishing.
Most doctors prefer it this way, as they get paid immediately and don't have to fight with the medical aids. They leave that to you.
Was there anything on the invoice which said "you as the patient are ultimately responsible for the payment of this bill"?

[FatBoySlim]

ok Gary , this is the situation, in all 3 cases I submit a number of invoices, for hospital, medication etc, its always the anaethetist one which is ignored. You work for these losers perhaps?

The reason that the ignore it the first time is that they expect you to pay the doctor directly and they will then refund you once you have paid.
This is now common industry procedure. The days of them paying the doctor directly are rapidly diminishing.
Most doctors prefer it this way, as they get paid immediately and don't have to fight with the medical aids. They leave that to you.
Was there anything on the invoice which said "you as the patient are ultimately responsible for the payment of this bill"?

Sent from my Samsung Galaxy Tab

[Kosmik]

Hmmm, time to wade in.

FatBoySlim, I've never had a anesthetist bill outright rejected from discovery and I must say their claim process is very transparent. However, as to the fact of Discovery paying a portion and you being liable, as has been mentioned, this is standard practice across medical schemes and the different packages that they offer. There are additional options though. For example:

My wife recently underwent surgery ( two weeks ago ). I'm on Coastal Saver and the terms of my plan are that they cover the cost of Coastal Hospitals within the agreed rate and all specialists at 100% MA rate. Now my hospital bill was R6.5k, Specialist R3k and Anesthetist R1.7k. Discovery paid the hospital in full and a portion each of the Specialist and Anesthetist. However I have GAP cover as well so I submitted the same bills to GAP and they will pay me the shortfall between the MA rate and the specialists and anesthetists actual rate. Gap cover is really cheap and well worth it. A lot of companies actually already have their employees on GAP but most folks don't bother to check.

[Garyvdh]

ok Gary , this is the situation, in all 3 cases I submit a number of invoices, for hospital, medication etc, its always the anaethetist one which is ignored. You work for these losers perhaps?

No, I just know how they work. It's all there spelled out in black and white in their policy manual.
Have you perhaps thought of actually communicating with them and asking them why over the phone?
If you just submit the invoices alone without any verbal communication they are just going to follow their standard operating procedure.
But tell me... if you think they are losers, why don't you move to another Medical Aid?
Consult most brokers in the country and you will find that Discovery is one of the highest rated, financially sound operations in the country.
But you are welcome to use any losers you want.