Discovery Health Medical Aid
Reviews and Complaints

I was informed by discovery to pay R3000.00, i paid the R3000.00 as discussed with the consultant. this was during the course of september 2010. I poske to discovery consultants again during december where i was informed that everything was fine and i paid in whatever was still required in December. Yesterday i was informed that my policy has been cancelled since september 2009 because of a short payment of R122.00. i spoke to the consultant yesteday and informed him that why in the world would i pay R122.00 short if i paid R3000.00 on the same day. Now they tell me of of a declaration of health form i am supposed to have sent to them in September, which i donot know about. I asked them to check the recording of when the consultant called and told us that we should pay in R3000.00 and now they cannot find the recording. I cannot remember the consultants name or the date exactly when they called, and i dont think any one can remember the date and times or even names of consultants that call them. I know sit in a position wherby myself and my family donot have medical aid active because of a consultants error in not telling me to deposit R122.00. This is totally ridiculous...

I have a very simple query that Discovery needs to resolve. But clearly this is too complex a task for them. This query has been going on for 3 months now. Each time I speak to an agent, they tell me my complaint has been resolved and that all is in order. Till next month, when I get a letter from them again about the same thing. I called Friday afternoon after receiving the same letter once again to speak to a manager, but of course, no managers work after 16h30. You cannot run a call centre without a manager? I called again on Saturday to get Mr A Gore's email address. Hoping he could sort out this 'complex' query, but was told by the agent that she would get fired for giving me his email address? I'm not asking for his personal bank account nr, just an email address. Clearly he does not care to be available to any client issues, I wonder if he has any clue what is going on in his call centre if you cannot get past the first agent that answers...Well after this, I had no choice but to go to the Council for Medical Schemes, seen as I'm not allowed to even send an email to the CEO.

A staff member of mine is on Keycare Plus. She needed to see a specialist and her GP referred her, sent the forms to Discovery and we got an sms with an authorisation number [protected] from Discovery. She then visited the specialist and now we get an email saying the specialist will not be paid. Reason: 'Your specialist visit hasn't been paid as you or your chosen GP didn't get a reference number for the visit...' Why have a medical aid, go through the correct channels, get an authorisation, only to be told you haven't got authorisation. In addition to this, the specialist actually needs to operate, and his office got an authorisation from Discovery for an op, and we have already done pre-admission. Do I have to assume that after the op, we will be told that we need to settle the bill as we had no authorisation? I thought Discovery was founded on the principal of sound administration, claiming superior claims administration compared to other schemes. They do not live up to that anymore. What is happening? I do not have time to waste when we have done everything we needed to do from our side following onerous procedures to ensure we get the service we are paying for!

Once again, Discovery did it. I am still shocked by the promise made by discovery prior the birth of the baby. I specially made an enquiry a month before my date of delivery, enquiring about the bills for maternity hospitalisation so I can keep some extra cash for the bills but they said there is no need to worry as everything is approved and they will cover everything from birth day but to my surprised I have received a bill that states that I need to pay 5290.00.Discovery will only pay 2300 and I should pay the reminder of 3000

I called the call centre and they said the reason was the specialist did not charge according to their scheme rate but the specialist is within their network and i have been with the specialist since January, nobody told me that there will be a problem afterwards which I clearly do not understand more especially after all the approval they gave me.

Please assist, this is uncalled for, now we have to pay the bill that is not planned, Discovery can I please enjoy my bundle of joy without demanding any payments from us, This should be the happier times. What about the 710.00for the date of 10 March 2010.Are they going to pay or not.

I would like to inform you of the terrible service that I recieved from the Call centre agents, their supervisors and the manager in the department at Discovery. I have cancelled my Medical aid and requested my savings portion to be paid out into my banking account. The first agent I spoke to was very polite and told me that the funds had been released however my banking account was closed. I was advised to complete a change of bank detail form. I decided to call my bank only to find out the account was still active so I called Discovery back. I spoke to the rudest man, Lebo, who told me with a very appaling attitude that it's my fault because the 5 in my bank details looks like a 6! I asked to speak to a higher authority and spoke to the Relationship Manager Charmain Erasmus who gave me the exact same story so I asked for the Manager, Jannie van Niekerk. He was just as rude, he never listened to a word I said, spoke over me the whole time and basically did nothing to resolve the matter. I am still waiting for my cash refund and have never dealt with such incompetent, rude people in my life. When Managers deliver poor service you have to wonder about the staff they manage!

I submitted my application form to add my daughter to my Mdical aid on 8 December 2009. I received and reference number back to confirm that the email and application was received. I then needed to get her vacinations done and discovered that my daughter was not added to my Medical aid. 3 months later, Nothing has been done about the application form that I sent in! I then called in on 3 March 2010 to follow up and resend my application form and still NOTHING has been done. My daughter still does not exsist on my Medical Aid.

I have spoken to a numerious amount of staff at Discovery Health and no one has bothered to call me to inform me what there delays are and if there are any problems. I have had to call in everyday to follow up on this and still NOTHING has been done.

If anything had to happen to my daughter she would not be covered as Discovery Health can not do their jobs!
I think this response and Discovery Health's service is shocking!

My wife was hospitalised which obviously means that all doctors bills must be paid out from the medical scheme, which has not been done. I, ve been battling for a month now to get all the bills sorted out, but no luck yet. i, ve made numerous phone calls (duration of calls 45 to 90 minutes) they keep transferring you to the next department which means you have to explain the whole issue to 5 different people. almost have more reference numbers on my phone than contacts. and guess what? still not sorted out! But when You owe them money they are quick to deduct or phone for payment. This is the worst service I have ever seen in my entire life and this is supposed to be the best medical aid. So if you have any queries dont even waste your time by sending email's or making millions of phone calls, because it wont help. You're simply just wasting your time and money.

Hi, Today I recieved a call from ITC saying that I am listed on ITC by Discovery. I called Discovery regarding this query and they explained to me why I was owing R2700. I have no problem with paying the R2700 but I do have a problem regarding the extra cost on the ITC board. I was not contacted regarding this query and I do not understand how, if one does not respond to letters why are they not called. the lady that I spoke to Viloshnee Kisten told me that it was not part of the policy to call clients in June-the policy became active in August. My question to Discovery is in August, why was I not called!? Handing someone over before you have exhausted all contacts is not legal! I would like to be taken off ITC and pay the outstanding R2700. Please may I have this matter resolved with the outmost urgency.

I have been a member of Discovery Health since 2002 and have always been happy with their service until I went onto their Oncology program in 2007. The oncology department is a 'law unto themselves' and do not respond to queries. I sent my query regarding unpaid bills by e-mail on 3 June, 7 July & 16 July 09. I also faxed the query to the oncology department on 12th June 09. I followed up with phone calls to Sandra Alexander but, to date, I am still awaiting a response. There is no area on their web site where one can lodge a complaint and their call centre does not handle oncology queries. I am very disappointed with the lack of service from Discovery's oncology department.

Discovery are paying me for my claim for my gp submitted for service dates 14 September, 15 September and 26 September, but HOW can I possibly have the following:

Reason Code 42: You are responsible to pay the balance of this line as you have run out of funds in your Medical Savings Account.

I AM IN MY THRESHHOLD so how can this be? You have paid the rest of this account from threshhold?! Please correct this immediately and PAY me what you owe me, i.e. the injection for the amount of R194.31 on service date 14 September. I need to pay this amount to my doctor asap.

My wife has been diagnosed with Hyperthyroidism which is not covered by the Chronic Illness Benefit, while Hypothyroidism is. Both are life threatening conditions, one disease is for an overactive Thyroid gland (Hyperthyroidism) while the other is for a under-active (Hypothyroidism) Thyroid gland. It pains me to understand how one can be covered while the other is not! Hyperthyroidism can also lead to a number of conditions, such as heart problems which are covered by the scheme where as the cause of the condition is not! Its like only covering conditions effecting your right leg and not your left!This is shocking and it is just spelling out the problem I have with medical aid, you never know what you are really covered for. Just now you get some strange new disease and they tell you its not covered because its never been diagnosed before! Its like your motor insurance company only insuring you against accidents between Audi and BMW and if a Opel hits you, you're not covered!

Having paid money to both Virgin Active and Discovery Vitality in April, I was highly embarrased to find out last Friday that my membership to both organisations had been cancelled. The cancellation dates back to February 09, despite contracts being concluded in April 09. Calling both call centres has proven to be an nightmare, with Virgin Active blaming Vitality. Vitality on the other hand have promised on 3 occasions to get someone to call me back. The last promise was yesterday (81009) where I was promised that a manager would call me within the hour - A day later I am still waiting.

I tried to add my partner onto to my existing Discovery Medical Aid account now that we are living together by submitting an 'Additional Dependant Form' to them on the 25th August. As of today, I heard nothing, nearly a month later! I call their help centre and I am told that the application has been denied due to their 'rule' that I cannot add a dependant onto my account if they are coming from a lower Discovery medical scheme. Now, no where on the application form does it mention this and neither did ANYONE inform me that the application had been denied...eventhough I had cancelled my partners medical aid already! They also did not inform my partner when she cancelled her account that she could not be moved onto my account!

This is totally unacceptable. How can I be denied adding a dependant to my account...it will effectively be doubling my contribution to Discovery Medical Aid...but I guess they dont want my business?!? It is also unacceptable to not infrom me about this. Goodness knows how long my partner would not have been on medical aid!

If you enjoy being dictated to by Discovery as to what you can and cannot do on your account, then by all means become a member...

To whom it may concern

My husband had undergone heart bypass surgery on the 8th of april 2009 at st augustines hospital. The surgeon who performed the operation on him was mr m. K. Odayan.
On recovery we were faced with unpaid bills amounting to r25 064, 24 which were not covered by medical aid due to a billing problem they are experiencing with the above surgeon. The doctor had bypassed five arteries. He billed on code 1348 as well as using a modifier code and code 1275. What is not making sense to me is that the medical aid paid for one bypass and did not pay for the other four. How did they expect a surgeon to open my husband up and do one bypass?

However on admission, authorization was given by medical aid but I was not informed of any problems or liabilities I would have had to cover personally. The day before my husband surgery, we asked the surgeon before signing the consent form of any shortfalls that we would be liable for, he mentioned that he charges up to 200% of medical aid rates and we were covered for 200%. However medical had paid full for all codes the surgeon had charged except the 4 grafts. This does not tell me that the surgeon had charged over medical aid rates, so why am I left with this bill of r25064-24. Had discovery health or the surgeon informed me of this problem before the operation, I would have got another surgeon whose billing is in line with discovery to operate on my husband.

Discovery medical aid does not return calls neither do that keep you informed of the progress of your complaint. I am now waiting for four months.

Although I am liable as the member, I will not take responsibility for someone else’s mistake or a simple problem such as billing problem between discovery and the cardiothoracic surgeons board. Please can someone help me, as I am now prepared to go public (To the media) with my problem so that other discovery members are not faced with the similar situation. Time is now of essence.

I moved to Australia with my family on 13 August 2008. I contated the Customer Services department at Discovery Health to inform them of my cancellation of my medical aid as well as new contact details of myself (including e-mail address and my mothers' postal address details in Gauteng, South Africa). I still have the e-mail from the Customer Services Consultant where he cc'ed me on an e-mail to the department who were supposed to update my details on 1 August 2008, specifically stating that we were moving to Australia.

2 weeks ago we were informed by my father-in-law in Bloemfontein, South Africa, that I debt collector had turned up at his business (which was my previous work address), stating that we were listed on ITC and had to pay R2500.00 outstanding to Discovery Health. He paid the amount.

I have copied the e-mail correspondence between myself and a consultant at Discovery Health after her reply to my request as to why they never contacted me was that that had indeed tried to contact me. Sent me 4 letters (which to this day has not arrived at the postal address I supplied on cancellation - my mother will confirm this) and tried to contact me on our South African contact numbers. No attempt was made to contact me on my e-mail address or the new postal address that I supplied.

My last e-mail to her, has gone unanswered. In there I wanted her to supply me proof of the fact that these letters were sent to the postal address which I supplied as well as why my husband was listed on ITC while I was the principle member. There could be proof or explanations for this, but Discovery has decided to ignore me.

I feel (as per my comment below) that with so many people leaving the country, they should have something in place in their system to be able to contact people who have moved overseas.

I do not dispute the amount we had to pay. I dispute the fact that they placed us on ITC and caused major embaressment with my husband's parents because of their lack of professionality.

Ps c the copied correspondence below.

Thank you,
Gillian Willemse

RE: Discovery Health account‏
From: Johann and Gillian Willemse (jos.[protected]@hotmail.com)
Sent: 13 May 2009 01:33:24 AM
To: [protected]@discovery.co.za; [protected]@discovery.co.za; [protected]@hotmail.com ([protected]@hotmail.com)

Good Day Pamela,

I don't understand. The last e-mail I referred to (and attached) in my previous e-mail, I received confirmation that the operator confirmed my LEAVING SOUTH AFRICA and moving to AUSTRALIA. How is it possible Discovery would think it possible to CONTACT me by sending letters to a POSTAL ADDRESS in SOUTH AFRICA and by trying to phone me on a SOUTH AFRICAN number? What about my e-mail address?

The second thing I don't understand is your statement: "Since the amount is now paid, we have sent a request for your name to be cleared off ITC. Please note that our banking details are included in the document attached. Please email me the proof of payment in order for this to be done." What do you mean?

I want confirmation of the postal address where these letters were sent to AND I want to know, why if I am the principle member, my husband's details appear on the attached letter? Does this mean all the letters and the ITC listing was in his name?

I would appreciate your speedy response to a matter that could have been sorted without any problems if someone at Discovery Debt Collection had just taken the time to understand the situasion and handled it appropriately. With so many people leaving the country, is there no other way for Discovery to make sure that they can be contacted after they've left the country other than to send the debt collector if the SOUTH AFRICAN details don't produce results? This is obviously part of the customer service department. I would appreciate feedback from them as how they handle situasions like this.

Thank you,
Mrs. Gillian Willemse

"Do not let the past dictate who you are, but let it become part of who you will be."

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Subject: Discovery Health account
Date: Tue, 12 May 2009 10:54:40 +0200
From: [protected]@discovery.co.za
To: jos.[protected]@hotmail.com

Goodday Mr Willemse

We have received your query regarding the amount of R2228.00 that was outstanding to Discovery Health. I have attached an account of this amount.

Also, please note that we sent you 4 letters informing you about this debt; on the 5th September 2008, the 7th October 2008, the 14th November 2008 and the 16th January 2009 respectively. We did not receive any response; after which we attempted to contact you by telephone, to no avail.

After a certain time has passed and the debt is not paid, our system will automatically list a member on ITC or hand over the account to an external debt collection agency; as it happened in your case Mr Willemse. Since the amount is now paid, we have sent a request for your name to be cleared off ITC.

Please note that our banking details are included in the document attached. Please email me the proof of payment in order for this to be done.

Thank you very much for your query.

Pamela Buthelezi

Member Debt Administrator

Settlement Solutions

tel: +[protected]
fax: +[protected]
email to:[protected]@discovery.co.za

URL: http://www.discovery.co.za

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