Discovery Claims - Expert to review ?

Dolby

Honorary Master
Joined
Jan 31, 2005
Messages
27,951
We had twins on the 01 March and they stayed in ICU/high care for 3 weeks before coming home .

Now the 'fun' starts with the claims ... they're coming through fast and furious.

Sometimes they claim direct from the doctors
Sometimes I pay first
Some are unpaid
Others are fully paid
Others are partially paid
Others have codes / reasons for non-paying

There are about 20 different claims ... that can each broken down further ... and even further in some cases.

I'm not questioning what I owe (yet) - but I'm asking whether there is a someone that looks at these and does a full recon at all ?
 

Superjakes

Expert Member
Joined
Oct 2, 2009
Messages
1,787
Firstly - congrats on the twins! I hope they are healthy and not naughty.

Generally whatever happens in hospital is lumped together and claimed directly from Discovery - also visible as such on your claims history in the app or on the site.

Pediatricians (OOH) generally expect you to pay them directly on the first visit (as do other specialists), and they also tend to charge more than Discovery covers (if you have a savings plan). So there will usually be a co-payment that you can't claim from gap cover as it is not linked to a hospital stay.

Important to remember is that mistakes can happen from both the doctor's side or Discovery's side, so if something is not paid or paid in full, and you believe it should have been - contact Discovery. They have been quite helpful with us in the past. Sometimes it's just a wrong ICD10 code on the claim that causes it to get rejected, etc.

I hope my rambling helps.
 

SauRoNZA

Honorary Master
Joined
Jul 6, 2010
Messages
39,235
Most of the time when they don’t want to pay at all it means someone ****ed up the codes or the dates, assuming it all happened while in hospital.

Either the authorisation code is wrong, the item code or especially when it comes to the wee hours someone used the wrong date and/or there is a legitimate duplicate event but Discovery sees it as a mistake or duplicate invoice.

If they part pay that usually means it was processed properly and most of the time correctly but you hit the limits of your plan.

So my advice is start with the non-paid ones and chase those first as low hanging fruit.

If need be go to the Discovery office and sit down with someone.
 

GhostSixFour

Mafia Addict
Joined
Nov 9, 2009
Messages
14,195
Our medical aid covered everything for our baby in NICU - except, the formula that was given. I questioned this, saying that if myself or my wife was in hospital, they would pay for our meals, but they wouldn't budge. I mean, it was like R2k out of the close to R700k bill, so we ended up paying.
 
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