“I don’t want to spend what is left of my life fighting Discovery…” a desperate stage 4 cancer patient told Wendy Knowler.
What’s up with Discovery Health and its misallocation of cancer patients’ treatment claims?
I ask because in the space of a month, two of them contacted me, desperate for help in getting the medical scheme to stop deducting their claims from their medical savings accounts (MSA) instead of their oncology benefits.
The scheme deducts a fixed portion of members’ monthly contributions – between 10% and 15%, depending on the plan – to be used by members for their day-to-day, non-hospital expenses.
In Discovery’s words: “The MSA works like a bank account. What you do not spend, you carry over to the next year. If you leave the scheme, we are legally required to pay the balance to the new medical scheme you join.”
But many members deplete their MSAs before the end of the year – and in the case of the two cancer patients who contacted me, long before that, thanks to Discovery Health funding their cancer treatments out of them.
Early last month, Bernadette Head shared the desperate plight of her partner, Louis Jost, a member of the University of Kwazulu-Natal Medical Scheme, which Discovery Health administers.
They are both in their seventies.
The scheme approved his cancer benefits, but the cost of his PET scan in April, after chemotherapy and radiation treatment – almost R12 000 – was taken out of his MSA instead of his oncology benefits.
“So our normal day-to-day benefits are now depleted,” Head said.
“We have been battling to get this money reversed for three and a half months now.
“They keep saying it will take two to three days and in the meantime, we’ve had to pay for all our medical expenses in cash.
Finally, Head said, “after throwing all my toys”, the scheme returned that amount to the savings account. “But a week later, they took R8 712 for no reason and left our benefits depleted.
“All this money should have come out of Louis’ cancer benefits, not our savings. We are just so frustrated.”
I took up the case with Discovery Health.
Stephen Johnston, head of in-house schemes, apologised for how Jost’s claim queries had been handled. “This is not the type of administrative burden that we would like to put on any of our members,” he said.
“Although the [PET scan] approval was correctly loaded on Mr Jost’s membership, the claim unfortunately was incorrectly processed to be funded from the member’s available MSA.”
The scheme had since manually processed the claim to the oncology benefit, Johnston said.
Head confirmed that the amount had appeared in Jost’s MSA, so they sent through claims for doctors and medicine of just over R1 000.
Sadly, the relief was short-lived.
“Those claims were not reimbursed, and now that almost R12 000 has just disappeared from Louis’s MSA. Back to nil balance. I give up.”
Back I went to Discovery Health, and the issue has finally been resolved.
I asked: “What prevented the admin folk from acting on Ms Head’s numerous appeals for this mistake to be remedied, going back to April?
“She called countless times; she emailed, but no action was taken.
“The answer to this question – and a will to deal with the obstacles – would no doubt improve the member experience on a broad scale.”
This is how the scheme responded: “Following an internal investigation, we can confirm that both Mr Jost and Ms Head had attempted many times to reach out to our call centre to resolve the query.
“The servicing team is currently investigating these service delivery issues, which do seem to be very specific to this case, rather than being systemic or indicative of the high standard of service which our operations teams provide in the normal course of business.”
It’s not over
Well, not long after that I received a similar, but far worse, complaint from Hazel* of Pretoria, which cast doubt on that statement.
Two years ago it was confirmed that Hazel – a Discovery Health member for more than two decades – has stage 4 breast cancer, after being in remission for 24 years.
“Despite being on an approved treatment plan with several approved protocols, Discovery is unable or unwilling to allocate my claims correctly and puts thousands [of rand] to my MSA,” she told me.
“It’s time-consuming, frustrating and exhausting to sort out every time I have blood tests, a scan, get medication or see a doctor.
“And until it’s resolved, I have little to no MSA funds available for dentists or other things.”
To get resolution, Hazel said she has to send emails – separate ones for each claim – up to five times each:
I have requested meetings with no response; I’ve phoned, written letters and sent emails, all to no avail. Nothing improves, even when Oncology Escalations assures me it will.
She adds: “My biggest fear is that when my health fails, I will be unable to maintain the level of vigilance required to get my claims allocated correctly.
“With a nil balance MSA, I could then get into a financial mess with medical bills.
“I also don’t want to spend what is left of my life fighting Discovery…”
I asked Discovery Health: “Why does this patient, and likely many others, have to jump through so many hoops to ensure that their MSAs are not unjustifiably depleted due to misallocation of payments?
“And what will it take to spare Hazel and others this ordeal?”
A few hours later, Hazel emailed me to say that she’d received a call from someone in “Discovery Escalations”, saying the cost of her scans and blood tests had been reversed from her MSA.
“He assured me that it would all be sorted out and should I have any problems to contact him. That sounds great, but as I told him, he has so far neither done nor said anything that I have not heard several times before!”
Responding, Discovery Health CEO Ron Whelan began by recognising that the scheme had caused Hazel “significant frustration”.
Confirming that “certain claims were incorrectly paid from the MSA instead of the benefits available in the oncology treatment basket”, he said the scheme was investigating whether that was due to a technical issue, and, if so, whether it had affected other members as well.
“Should this be the case, we will ensure that any other claims that may have been impacted are corrected, too.
“All claims incorrectly paid from [Hazel’s] MSA have 1726286406 been refunded in line with her approved oncology treatment basket.”
And Hazel now has a “dedicated client relationship manager” to oversee future claims, “should she require any ongoing support”.
I have a feeling such relationship managers are going to be in high demand.
*Surname withheld.
CONTACT WENDY:
Email: consumer@news24.com
Twitter: @wendyknowler
*Due to the volume of emails Wendy receives, she cannot undertake to take up every case or respond to every email. Please include dates, reference numbers, receipts and other relevant details in your emails.
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