On your case: Discovery speaking in code
Wendy Knowler [ 29 April, 2015 09:32
“We are extremely sorry that the timing delay on this con ection impacted on Mi if-Ipe, which should not have
happened” said Discovery Health chief executive Jonathan Broomherg. File photo
Image by: Gallo images/ Thinkstock
Every day I get emails from customers of large companies who’ve spent days or
weeks dealing with call centre employees in a bid to get a problem sorted out,
with no success.
They’i‘e angry and frustrated, and understandably so.
Mortimer Hope was one of them.
A Discovery Health member of 15 yeais, his plan includes unlimited hospital cover for his family, at a cost of
almost R9000 a month. I-lope’s wife Julia was admitted to Milpark Hospital on January 12 and all went well
with the authorisation process.
She was discharged four days later, but last month Hope began getting statements from the hospital, followed
by a ﬁnal demand for more than
Rl2,000, relating to the hospital stay.
‘‘I wrote to, and called, Discovery Health on several occasions to try to resolve this matter but their response on
every occasion was that they declined the hospital authorisation and will not pay the outstanding amount of
R1 2,269.87,” Hope told In Your Corner.
“Even though I explained that I have a copy of the authorisation they insist that their records show that the
hospitalisation was not authorised, ” he said. “This obviously begs the question of why Milpark Hospital
admitted my wife Julia if they did not receive authorisation from Discovery Healtli. ”
Not wanting a blemish on his credit record, Hope paid the hospital the amount being claimed, but felt strongly
that he was owed a refund by Discovery, along with an explanation.
I took up the case with Discovery and got a very swift response, explaining that the decline was an automatic
one, based on the Discovery being supplied codes by the hospital which indicated frail care, something which
is excluded from cover.
While Discovery’s case manager at the hospital realised the problem and re-instated the authorisation, this
applied to the specialist’s treatment of Hope, but not to the hospital stay, for some reason.
“We have now corrected the information as regards the hospital claim, and will ensure that Mr Hope is fully
reimbursed for the hospital element of his wife’s treatment, ” said Discovery Health chief executive Jonathan
“We are extremely sorry that the timing delay on this correction impacted on Mr Hope, which should not have
1-lope has since been refunded in full, but he remains unhappy that this happened only after the intervention of
“I sent Discovery about ﬁve emails and made several calls, trying to get to the bottom of why the hospital stay
cover had been declined, ” he said.
“At no point did any of the agents or management explain the reason for declining the authorisation — they just
stated that it was declined and that I should check their website for more information. ”
Hope has been assured that each of his failed interactions with Discovery staffers will be “looked into” and
Good thing, because such service failures are grossly unfair to consumers.