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On you case discovery speaking in code


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Hope has been assured that each of his failed interactions with Discovery Staffers will be "looked into" and "addressed internally"

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On you case discovery speaking in code

  1. 1. 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.
  2. 2. ‘‘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 Broomberg. _ “We are extremely sorry that the timing delay on this correction impacted on Mr Hope, which should not have happened. ” 1-lope has since been refunded in full, but he remains unhappy that this happened only after the intervention of the media. “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 “addressed internally”. Good thing, because such service failures are grossly unfair to consumers.