Discovery Health Medical Aid
Reviews and Complaints

Discovery Health SA did it again. Suspending the account even if the payment was done and proof was sent to them
This is going on for 1 year now. Every Month the account is Suspended but the money is paid. Then you phone Discovery the (Supervisor) do not want to speak to you as she well aware of the problem and IT IS NOT THE PAYMENT, they will tell you that you are paying into the wrong account, but even if you do payment in 4 different account they will still say it is the wrong account . Sent proof of payment, for what you do not ever look @ it. Discovery is to quick to suspend account but were is the money you paid into there account.

Dear Sir

My family is currently under Discovery Key care for low income earners
This medical aid scheme was taken out by my spouse.
Last year Discovery renewed our 2014 benefits after we provided them with full information ie
-bank statements
-proof of income
-affidavits stating that main member was un-employed at that stage

We than contacted discovery medical aid to verify information and the consultant confirmed
that all was in order. This was done just before we went away for the festive period.
January 2014- Discovery deducted the agreed premiums.
February 2014- discovery deducted double the amount that was paid in January.

I have made several calls and made contact with discovery. Nobody can assist with.

Can you please investigate for me

Regards
Ahmed

Discovery Health SA well yet again you let me down. You failed to supply me with Medication, and then you tell me that I can collect it at Clicks but will have to pay for it but will refund me. Well what if I did not had a credit card or the cash to pay for the medication?

2 months ago I was told by your Manager at your Customer service Desk in Century City that you can’t be held responsible for Opitpharm not delivering as you don’t keep track if they are actually delivering the meds or not and it have been contracted out. I was shock as he basically told me that it’s out of their hands. You apologised then eventually for this mistake, but it was not 30 days later I had to run around calling you and trying to find medication as yet again you failed as a health care supplier. So on the 25 November when I wanted to collect the medication from Dischem I was told I can only do so on the 13 December. That would have been 14 days with no medication. Then after I sent another Email it was brought under my attention that Optifarm (whom we are not even registered with have requested the funds for the Meds) so you say you sorry but NOTHING gets done about this.

Then tell me that I receive Medication and did not pay for it as they put it through on Medical Savings. I know and you know that if they do that the Computer tells them within seconds if it’s been authorised or not. I did not request for them and they were not on me when I left the store. Then you only pay R372.49 of the R1033.96 that is owing to me. You did not ask me if I have taken this medication you just automatically deduct this. I have told you Thapelo Makgatho I have told you that the whole amounts need to be paid as I paid for it all.
I hope the 3 pictures will help you to understand what you owe me and I took you step by step.

Why does Ricky Farber has an email address: [protected]@discovery.co.za but never reply to emails himself. Do they know about these problems in the Company or do they just not care about it.
Nicola Wisbey maybe if you start caring for people you will understand how important this medication is but guess you don’t have to worry as you sitting in a nice office and as your boss get a fat bonus at the end of the year for doing nothing.
Ricky Farber I want to bring this under your attention as I do not think that any of this "mistakes" as Anthony Cooper calls them as no one in his office is held responsible for their actions. Then People like Jaco Thompson who is rude and call you up with the perception and to tell me that I have signed the new terms and Conditions of the Discovery Credit card. Well payment of your card use to have 3 options when I started with Discovery now there is 6 or 8. Then go on to tell me if I pay my bills on Time maybe this would not have happened. I have requested to his Senior Anthony that I would like an apology but still not received this. Only received the T&T the signed copy 2 weeks later after I had to follow up on this yet again.

But at least there is one person Kogi Chetty that took the time out of her day and explained to me more on the Healthy Benefit. Thapelo Makgatho, thank you to you too for your help on getting the tablets every time. Thank you.

Discovery membership no: [protected]. My husband was admitted to Unitas hospital on the 11th of July 2013 and discharged on the 13th of July. All accounts were submitted and one particular account for the Anaesthesiologist, Dr. Govind Discovery decided not to pay. First reason that was given is that the Gastroenterologist had to supply the PMA form, which Dr. Reichenberger did in July and then again in September. I had to then resend the documentation through again on the 11th of October as per the call centre agent’s request (ref: [protected]). The PMA documentation was then received and I was promised that the account will be paid. I then followed up again on the 28th of October (ref: [protected]) to check if the payment went through. Again, nothing was processed. This time the reason was given that my husband was not in Hospital on the 13th of July as per Discovery’s record and therefor Dr. Govind’s account will not be paid as Dr. Govind’s invoice date is the 13th. Discovery then claimed that Unitas records show that he was only in hospital till the 12th. I then asked the call centre agent to try and get Unitas to send through whatever it is they need to send through to get the account paid.
On the 1st of November I then again followed up, spoke to Lunga the call centre agent, on ref: [protected] on what the status is of the document they need from Unitas. She promised me that she’ll phone me back and get it sorted as the case has been escalated. I’m still waiting for her call….. I called again the following week and spoke to Rochelle, didn’t get a reference number. At least she called me back and said she’s working on the case with Unitas hospital and added that it’s really difficult for the call centre agents to call the hospital and customers as it’s only an “inbound” call centre and if calls need to be made it needs to be done after hours or during lunch hours? Nevertheless I didn’t get any feedback after that. I called again on the 8th and after spending 45 minutes on the phone and explaining the whole story again to a new call centre agent, he said that he’s spoken to Unitas Hospital and that he’s requested the letter from the case manager, Ntombi, which at the time was not in the office and was to return on Monday the 11th. He said he will give me a call on Monday after he’s followed up with Ntombi and gave me her contact details too, with a hospital case ref ([protected]). To date, I’ve received no call from Discovery and in the mean time I’ve been running around trying to get hold of Unitas Hospital to get this issue resolved.
I called Unitas Hospital this morning, the 13th and spoke to Nomsa, providing her with the case reference: [protected]. She advised that the reference given to me is completely wrong as it was for an admission done in February. That reference was not applicable to Vincent’s admission in July. She then updated me saying that the letter or update of admission was sent to Discovery on the 20th of July already advising that Vincent was discharged from hospital on the 13th pm. See below email from Nomsa. She also advised me that the admission file had already been sent to document storage as they only keep the records there for 3 months and she’ll advise me once the file has been received back from storage.
I’ve spent the past MONTH trying to get an account paid by Discovery, phoning every week, and every week having to retell the whole story to each and every call centre agent I spoke to. This is never mind the fact that the Dr hasn’t been paid as yet and when I log in to see what’s happening with the claim for Dr Govind, it shows as “zero”, and as per the call centre agent it means that it’s been reversed, and no reason was given to me as to why because Discovery is still trying to figure out what’s happening, after 4 MONTHS!.
I find this level of customer service utterly disappointing, having been members of Discovery for over 10 years, this is the kind of service we get?
I expect a person in a managerial position to provide me with constructive feedback on how this matter is going to be resolved and when Dr Govind is going to be paid. I also request that Discovery gives Dr Govind a call to explain as to why the account hasn’t been paid as I’ve been doing all the pleasing and explaining on Discovery’s behalf to the Dr the whole time.

From: Nomsa Motha [mailto:Nomsa.[protected]@netcare.co.za]
Sent: Wednesday, November 13, 2013 8:54 AM
To: Eileen Lombard
Subject: UPDATE THAT WAS SENT IN JULY

Kindly update gen x 2.5

Pt admitted via resus
Gastroscopy and colonoscopy was done
pt have also diarrhea and vomiting
bp 117/74 pulse 75 bg 6.1
meds i.v saline balsol perfalgan gaatriwin ciprobay vsl#3l

pt is discharged 13/07 pm

Nomsa Motha
Case Manager

Netcare Limited
Netcare Holdings T/A Unitas Hospital
Clifton Avenue/PO Box 15123
Lyttelton
0157
+[protected]
+[protected]
: www.netcare.co.za

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Spoke to Trevor Richards requested a breakdown of premium paid for one of the depandants since inception I was advised that if one belongs on a group scheme discovery is not allowed to disclose that kind of info I need to speak to my employer. Found that strange as I requested a certificate of membership telephonically (ref # [protected]) and discovery sent it to me and on there my monthly premium is noted (Trevor told me it cannot be sent to me). If I can get my mothly premium from [protected]@dicovery.co.za, surely Discovery should give me the breakdown as well.

when my dad cancelled my moms medical aid after being on there all her life i was told to discovery, to my understanding there would not be a 3 month waiting period as she has always been on a medical aid. she is a cronic patient and is not able to get her medication. When i explained this to discovery they said sorry cant help, this is not service please can someone advice me on what i can do

My child is hemiplegic and to improve her condition she has been receiving physio therapy and occupational therapy since 5 months old to help her cope with daily life. She goes for therapy once a week every month and because she needs special therapy she needs therapy to improve her condition for the rest of her life. We are on Discovery Health (South Africa) since 2012 and since then we have been trying to get approved funding for her sessions to be paid out of PMB and Discovery declines funding for my child from PMB. I have been through lengthy processes trying to get funding approved since 2012 but they keep declining. Discovery Health is a bad medical aid and a huge rip off. I am so disappointed and very unhappy with the processes that i had to go through and lengthy phone calls that never got resolved immediately to get approved PMB funding for my child's medical expenses for her therapy. I can relate to the many other complaints about Discovery Health from other people on this webiste and I can confirm that what they say is true. I can relate to the people that posted complaints on this webiste, their frustration and anger and their loss of hope with this medical aid scheme. I pay alot of money for my family to be covered but the benefits of this medical aid scheme is fruitless. I am considering another medical aid service provider. Dont use Discovery Health.

Discovery Health are refusing to authorize an admission into hospital despite the correct IC10 code and a letter of motivation by my daughters transplant physician when she needed to monitored for severe side affects related to her immune suppression therapy being reintroduced after a month of hospitalization with sepsis, bike duct surgery, UTI infection. She was discharged but had to be re admitted on 2 occasions as her reactions were so severe. As ONE of her many symptoms was a headache, the learned team at discovery - skilled at transplant medicine? NOT, have denied her Prof request to monitor her in house and treat her debilitating side affects beyond 24 hours of stay? Can a medical scheme play God like this, is our specialist then a fraudster in their eyes as are we? Is there no legal framework that given a specialists letters plus correct codes the validation to treat or does a team of amateurs dictate how severe things are and once again play "God" with someone's health.

i have developed an ingrow toenails medically known as onychocryptosis and has recently developed infection and it is painful and swelling to extend that i cannot wear closed shoes anymore. my GP referred me to a Orthopaedic surgeon because he doesn't have facilities to remove the nails. i received authorisation to see the specialist and the he said my nails should be removed so they can grow normal again. i was denied authorisation to be operated by discovery, they say they do not cover for this. i mean this is not me wanting to trim my nails or anything, i am in pain and cannot put on closed shoes in this winter, yet they don't care. i send them an email but nobody wants to respond. this is a matter of urgency. then i tried to make it better that if i can pay the doctors will the atleast pay for the hospital for those few hours that i will be doing the operation, No they don't care

I am a disabled female and am reliant on my medical service operator. I had claim for a much needed mobility scooter in 2011. My claim was appproved after the required documentation was submitted. The product is imported from sweden and only got delivered in 2012. The South African supplier requested a deposit so an order could be placed for the product, once the product got delivered the balance got paid, I kept no funds and the supplier received the full payment. Discovery Health are now accusing me of fraud, causing a over claim for 2012 as they have processed the claim as a 2012 claim although it was approved in 2011 and all my other claims are not being paid to me. NOBODY HAS THE SENSE TO UNDERSTAND and there forensics person Mrs S van Rooyen is extremely rude and ARROGANT, I need my claims paid to me and not be stuck between the two parties. Why am I involved? Why does discovery health not pay the supplier directly instead of involving the member? My claims are not for external medical apparatus but are being treated as if they belong together. I just need someone with sense!

Don't be fooled by Disovery Health and their Keycare benefit option. This medical aid plan hardly pays for any medicines (as prescribed by a rather small medicine formulary) and procedures. The only thing they will pay for is a doctor's consultation...I'm too scared to think of what will happen if I have to go to the dentist. Be careful...I didn't claim from my Keycare benefit for an entire year and this year (2012) when I got bronchitis and eczema, the medical aid refused to pay for all four medicines that I was prescribed by a keycare (designated service provider) doctor/general practitioner that I am compelled to visit, due to my medical aid plan. I have sat the entire day fighting with the unfairness of a medical aid to which I religiously pay my monthly contributions (on time, evenry month) and yet they decide to NOT pay for a medicine claim that came to R115.63. Be vigilant, be careful as to how you will go about choosing your medical aid and cover and what you are entitled to vs what you originally thought. They have also changed the medicine formulary for 2012 and have taken off a number of medicines (common, vital medicines, including antibiotics) which are necessary and commonly prescribed forms of medicine to patients with common conditions such as colds and flu. Be careful and take care, stay healthy, choose wisely

I have changed jobs so my memberships also changed with discovery. There whas savings left on my MSA and I thought well if there is something coming throught late it will be covered. Now in FEB I get an sms stating im being blacklisted for R350.00.
I havent received letters, phone calls or anything. The adress they have is older than 2 years. My cellphone number is still the same. How could they sms but not get hold off me trying to phone or leave a message. They also have my new details, company number, email ets, they could contact me there. But no, the rather dont do their jobs and get me blacklisted for being USELESSSSSS. I feel this is unfair. I always pay my accounts on time, and have debit orders. Now my whole credit record is ruined.
And there is probably nothing I can do. Im being blacklisted so why pay this then hey?

Even after numerous requests as well as a letter from my Neurologist requesting and warning that I cannot use Generic versions of the Medication I needed, Discovery blatantly ignored our requests and still did not pay for or refund the Chronic Medication (even though they are bound by South African Law to cover Chronic Medication) I needed because I didn’t use the Generic version. The Medication I use is for Epilepsy and the Seizures come with no warning and can be Fatal. Due to Discoveries dangerous apathetic attitude I was forced into a bad financial position as well a dangerous medical position and I am now out of pocket by thousands of Rands. It makes me wonder how many other people are being put in dangerous health situations and being ripped off by Discovery Health. I have been trying to get Discovery through various departments to come to the table for over a year now. I would like to know where is my refund and don`t tell this matter is closed like you continue to do because it isn`t and never will until I am refunded.

Good day
My name is nancy both.
I had a medical aid (Forced by the company) with discovery. I was in hospital with internal bleeding in my lung!
On the reception in sunning hill hospital, I have spoken to discovery myself (July 2011) numerous times making sure all procedures are covered, and was told that the mri and ct same as the heart scan are fully covered that was confirmed by a consultant! Their calls are being recorded but discovery refuses to let me listen to the calls!
As I finally came out of hospital I lost my job, which meant I had to cancel my discovery. Then I was informed that the savings account was used when I was admitted to hospital, which is wrong according to their promises! About 3 months thereafter I started receiving bills from doctors saying I owe them money. How can that be, as I was fully covered and admitted to hospital, on a comprehensive plan?
So I have paid some of those bills (added up to over 1000 rand). Finally (I thought) then I received a bill from discovery saying I owe r2300.00! I have sent numerouse e-mails enquiring on where I owe the money, and I have been told that my savings account was use while I was admitted. However when I joined the medical aid I choose it, because discovery clearly stated that if you admitted to hospital no savings account will be used!
I have sent more than one fax, calls, e-mail asking for settlement, no answer was received from discovery!
Now I have been handed over to their debt collection. The debt collectors only sent sms, and if they call they do not provide a company name, nor a name of who you speak to!
I have been threatened to get deported, someone will come and get the money, they come to my house ect.
I have spoken to them today [protected]) and requested a letter sent via post - i’ve been told not to be difficult, if not they will come and get the money! I mean really now? I’m not going to pay one who sends me a sms wanting money? No company name? No letter no nothing just a call from a random person?
Please someone help me, because that is a scam! And I will not pay, until I get the recording from the calls, and a detailed statement! And I will not pay legal fees, because I made contact!

My membership Number with Discovery is: [protected]

I am on key care plan with Discovery Health because I do not have work as a result of my illness which affects my mental state negatively and is aggravated when I get stressed out. I suffer from front lobe epilepsy and cannot hold a job now for over 5 years. My problem is that Discovery keeps on nagging through their call centre pestering me about my income status a number of times a year. They call me on my cell phone (I dread talking on cell phones as I believe it makes my condition worse)and interrogate me for long periods to find out if my status has changed. I keep on telling them that I am getting more sick because the nature of my illness is as such; but they do not back off and keep on and on and on to irritate the living daylights out of me. Now I notice that they have put my premium up to maximum without even as much as a letter of explanation why they did that. I did tell the lady from the call centre that my status as an income earner has not changed and that Discovery does not even want to pay for my chronic medicine and that I have to go to the state hospital monthly to get my epilim and that by itself is a big challenge. I am very upset because I am living off the proceeds of a property of mine that I was forced to sell a number of years ago in order to make ends meet and now Discovery is ciphering the last little bit of savings that I still have left. Please give me some advice on what I can do to this company that keeps on bullying me like this. My brain is not working well for a number of years now and Discovery Health is actually making it worse by traumatising me continuously. I think it is disgusting of them that they blatantly went and put my premium up to maximum because a call centre employee of theirs didn't like my attitude. Who can blame me when this company teaches their call centre people to terrorize people like myself who have a disability? I have given them proof of all they asked for in the beginning and they still keep on and on and on with their nagging irritations. I hardly ever go to a doctor. The only reason I want this cover is so I do not end up in a state hospital if I happen to be in an accident. My record will show that I see a doctor perhaps once or twice a year; yet they bombard me with stupid and irritating questions. They make me very ill with their terrorizing tactics?

I joined Discovery for the second time in April this year (2011) and the first premium of R445.00 was debited from my bank account ahich was to cover me for the month of May 2011. I visited the doctor twice in May and due to a technical error, my plan was cencelled by Discovery. I was told that since I was not entitled to be covered, I would be reimbursed whatever was due to me after the Doctor whom I visited was paid. Discovery then debited my account for a further R890.00 at the end May 2011 after the cover was cancelled. I then received a call from the Doctor telling me that Discovery was refusing to pay them because my cover was cancelled.
It is now already almost the end of June and I still didnt receive any reimbursement of any monies that was taken by Discovery. It is unfair that Discovery should have taken so much of my money and refuses to pay the Doctor's fees which is only R300.00 from what the Doctor tells me.
Discovery was so quick to cancel my medical aid due to a minor mistake but they are sure to take money that do not belong to them.
Imagine doing this to a good few poeple?
Discovery is just getting rich by stealing from the poor.
I wouldlike my money returned to me and if Discovery does not want to pay the Doctor, then they must return the entire amount and I can then pay the Doctor myself.
It is really tough and I chose to take medical aid so that I can have peace of mind in case I need medical care.

Discovery in all of its alleged polished marketing glory is the biggest scam being perpetuated in South Africa. They have zero credibility when it comes to doing what they are contractually obligated to do!

Don't believe me ... seriously read the blog at http://www.discoveryscam.com and you'll know that this company is absolutley without a doubt a CROCK!

Dear Discovery,

I am basically on my knees with tears in my eyes. My daughter has got a rare life threatning disease and Discovery keeps on shooting down for us to take out Chronic Illness Benefit for her. She was diagnosed with this disease at the age of 4 months. She is now 2 yrs and 4 months almost and still i cannot get her approved for Chronic Illness. Her Pediatrician (Dr HP Van Der Merwe) has also send motivational letters to confirm this. Her diagnostic code is: IDC-9-CM Diagnosis Code 255.13. Please i am pleading with you. We pay an enormous amount every month on medical bills and we pay our discovery plan every month, but Discovery does not want to assist in this. This is a life long illness, it will never be fixed, unless God steps in and make her healthy again. I have had no help from the staff at Discovery, they keep on putting me through to different people and no one is willing to help me. Can someone please see this as urgent and help and make our families life a little bit easier than to sit and worry every month if we are going to have money to buy her her medication. This is a rare disease, but becoming more common. I feel that discovery should put this on there list of cronic illnessess, it will help allot of people. Please Please i am begging someone to assist me and help me ! Worried parent - attached is a photo of my daughter - please help and make her life easier especially for when she gets older.
kind Regards - Nicolette De Candia - Paarl South Africa

I requested an upgrade on my membership in December, but it was never done. I have logged several calls and sent a number of emails yet to no avail. I then in January 2010 approach our Company Broker (Samantha) to assist me as I have had no joy from Discovery regarding my upgrade. (I’m employed with NUS Consulting). I then left it in her capable hands to follow up and resolve them matter. She requested my membership number, which I provided. I once again left it at that and awaited confirmation that I was now upgraded. I even submitted a claim in the month of February March’ 10, which to my dismay was rejected. I queried this and realized that I am still on the hospital plan with Discovery and was never upgraded, only realizing that the Company broker had also not done what I requested. As we are subsidized by the firm I therefore did not bother to follow up on this, as one would assume that once employed with a firm all would be covered under one. No one from Discovery had taken the time to contact me, as they apparently left A MESSAGE for me to call? I all of a sudden rec a email re client services re a call logged, which the broker did? Why was this not the case in DecJan?