advertisement
Question
Posted by: Sanet | 2012/07/17

Discovery came to the party at last

Hi, I just need to tell you that Discovery actually approved and additional psychotherapy sessions for me for this year! I am quite surprised. I depleted my benefit by needing physiotherapy and the frequent therapy sessions this month.
I actually believed my psychologist was wasting her time by submitting a motivation. All she did was complete the form and send my multi axial diagnosis through. And although I''m Bipolar 1, my registered diagnosis is for Bipolar disorder, unspecified. It just shows you what persistence can do.
I also took them the the CMS because they paid my in hospital mental health claims from my savings account last year. Within 2 weeks all my claims were reversed. And earlier this year all the additional out of hospital claims, that I paid from my own pocket was also reimbursed to me!
Members should not take nonsense from their Medical Schemes. They get away with far too much because people are uneducated. I used to work in Pre-Auth and Case Management and have knowledge of PMB''s.
Discovery also retracted my authorisation for my last admission to hospital, and I fought it up the the Executive Office and was allowed my full 21 days in hospital. Another patient to whom it happened packed her bags and went home!
I wish someone can make an easy guide for the public on what expectations they should have from their scheme.
If in doubt, call the Council for Medical Schemes. They are extremely helpful when enquiring about unpaid claims and PMB''s. You''ve got nothing to lose.
I''m just glad that they at last did something right this year.

Not what you were looking for? Try searching again, or ask your own question
Our expert says:
Expert ImageCyberShrink

Pleased to hear this. It goes to show that it is always worthwhile for the therapist / doc to submit a well-written motivation, rather than just giving up, as some of them seem to do too easily.
I do so agree that people should be much more assertive in asking for proper and sensible value from their medical aids.
Coincidentally, from pals who are good and caring GPs, I hear stories of personal distress, as some medical aids apparently now insist on paying the patient directly, even if the patient, having already received the doctor's care, then choose to keep the cash and spend it on themselves, rather than paying the doctor.
I like your idea of a guide to what to expect and demand, thouh there may be major differences between medical aids, and it'd need frequent updating.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

3
Our users say:
Posted by: Linus | 2012/07/17

Well done Sanet - and thanks for taking the time and trouble to give us this info!!

Reply to Linus
Posted by: Maria | 2012/07/17

That''s awesome. I also got them to reverse psych visits they paid out of savings, and put it against PMB instead. But of course NO ONE ever tells you about this, I''ve told several people about PMB who have never heard of it.

Reply to Maria
Posted by: cybershrink | 2012/07/17

Pleased to hear this. It goes to show that it is always worthwhile for the therapist / doc to submit a well-written motivation, rather than just giving up, as some of them seem to do too easily.
I do so agree that people should be much more assertive in asking for proper and sensible value from their medical aids.
Coincidentally, from pals who are good and caring GPs, I hear stories of personal distress, as some medical aids apparently now insist on paying the patient directly, even if the patient, having already received the doctor's care, then choose to keep the cash and spend it on themselves, rather than paying the doctor.
I like your idea of a guide to what to expect and demand, thouh there may be major differences between medical aids, and it'd need frequent updating.

Reply to cybershrink

Have your say

Thanks for commenting! Your comment will appear on the site shortly.
Thanks for commenting! Your comment will appear on the site shortly.
advertisement