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No co-payments needed for procedures pre-booked in December - Discovery Health

21 January 2019 11:28 AM
Tags:
Discovery Health
medical aid members
2019 medical aid increases
Discovery Co-payments
A Discovery Health client was shocked when he was told he was liable for R5000 co-payment for a procedure. Discovery explains why.

Discovery Health has recently moved a number of hospital procedures from the big general hospital facilities to day hospitals.

The company argues that the changes are far more cost-effective and sustainable in the face of increasing medical costs for patients.

A Discovery Health client Colin is at loggerheads with the company after he was told about an R5000 co-payment that he needs to pay for a procedure to be performed in January but booked for in December because it was a hospital not on the newly released list.

In response, Dr Ryan Noach, Discovery Health deputy chief executive explains that it is experiencing some challenges in the execution phase of the changes made, as the list of hospitals was only released late.

Read: Discovery Health defends decision to shift certain ops to day hospitals

We take full responsibility for the late release of both lists.

Dr Ryan Noach, deputy chief executive of Discovery Health

In order to make amends, Noach says authorisations for all cases booked in December for surgery to be performed in January will be honoured, meaning clients won't have to pay the co-payments.

For those cases that are new, meaning authorisation obtained in January, in those cases, we will apply the scheme rules and the scheme rules will, unfortunately, result in a co-payment.

Dr Ryan Noach, deputy chief executive of Discovery Health

In Colins case, Noach has agreed that there's been a confusion and that he won't have to pay the R5000 initially required.

We do continue on a case by case basis to look at each case and if it was booked in December and is for a January date, in all fairness to the member we will drop the co-payment.

Dr Ryan Noach, deputy chief executive of Discovery Health

Those clients being told they will have to make the co-payment is an error he says.

This is an error we are aware of and if anybody is experiencing this error I would invite them to contact us immediately. We have established a protocol on a fairness basis on cases booked in December for January that weren't aware of these rules, we must act in good faith and honour the members' authorisations.

Dr Ryan Noach, deputy chief executive of Discovery Health

To hear the rest of the conversations, listen below:


21 January 2019 11:28 AM
Tags:
Discovery Health
medical aid members
2019 medical aid increases
Discovery Co-payments

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