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Discovery – Please Clarify???

Do you know what really pisses me off? Feeling robbed by big business! Feeling like we’re being discriminated against by big business because our journey to family creation followed an alternative path. Feeling ignored and side lined by Discovery because we’re forced to conform to their ridiculous policies!

Let me explain….

We have a Discovery health hospital plan. Walter is the main member and Ava and I are dependents on this plan. The week before Hannah’s placement we contacted Discovery to have her added from placement date (24th April) to our HP. After jumping through all the required hoops (signed affidavits from our social worker, certified copies of our ID’s etc etc) we were informed that because we weren’t adding a new born, biological child, we would not be able to activate her membership from date of placement but would only be able to cover her from either the 1st May or have to pay for a full months cover from the 1st of April, even though we only required cover from the 24th of April. This cost us R600 of unnecessary cover because according to Discovery, they don’t offer a prorata rate for adopted children not placed at birth or biological children not being covered from birth. When we returned from Cape Town, we discovered that Hannah had in fact not been added to our HP from the 1st April as we had requested and so Walter had to once again contact them and go through the loong process of explaining our situation before their ripped us a new one and charged for a full months cover, even though we only required cover by that stage for 4 days of the month! Do you know what it’s like to deal with a call center agent about adoption…???

Now just to clarify….

With the change in the child act, the placement from birth of adoptive children is near impossible. The new child act states that the baby needs to be in a place of safety for the duration of the 60 day consent period, thereby making Discovery’s clause null and void. The only time this clause would apply would be for couples who are adopting via the use of a surrogate.

It really isn’t about the R600, but rather the principle of the matter for us. Why should we, because we are infertile and have adopted children, be required to follow a different set of rules than other families? I feel that Discovery SHOULD offer us a pro rata rate for the month of April, they SHOULD relook their policy in this regard and it is wholly unfair and frankly feels like day light robbery, a way of making a quick buck for doing frankly sweet f*ck all!

The only way we were even able to get a response from Discovery was by taking to social media as their call center were unwilling and unable to even offer us an explanation. Their “Executive Relationship Manager” responded with the following email:

Dear Sharon

Thank you for speaking to me earlier.

Please see the following timeline of events regarding the addition of Hannah to your membership:

  • We received the application on 16 April 2013
  • The application form was captured and checked on the same day and moved to underwriting
  • On 17 April 2013 we called for the medical questions to be answered and for the affidavits from the main member and social worker as the adoption process is not yet finalized.
  • We received the information on 17 April 2013
  • Hannah was activated on your policy on 18 April 2013.

The normal turn around time for an application form to be processed is 4 to 5 working days if no further requirements are called for, therefore the application was processed well within the communicated time.

We received a request for Hannah’s start date to commence on the 24th of April 2013 (this is when the baby was put into your custody). Discovery Health cannot start a dependent half way through the month unless it is the child’s date of birth and therefore, we activated her effective 1 May 2013.

Mr van Wyk contacted the call center earlier today and changed Hannah’s date of entry to 1 April 2013.

As per our Scheme rules, if the adoption process is not yet finalized we will need affidavits to be completed in order to process the application form. This is to ensure that the members have started the adoption process:

Discvovery BS

If the adoption is still in process and the baby is not being added from date of birth, then the baby is subject to full underwriting.

These rules are also applicable to members adding their biological children onto the Scheme. The child can be added from their date of birth free of underwriting. If the member selects a different date, full underwriting is applicable.

We would not allow the children to start mid-month and unfortunately cannot pro-rate the premiums.

I have attached a copy of the underwriting protocols to confirm these details.

Kind regards

Genevieve Fredericks

Executive Relationship Manager

Discovery Health

Tel + 27 11 529 4455

Fax + 27 11 539 3291

URL www.discovery.co.za

Does this seem life fair business practice? Does it seem ethical? To take a full months payment when only a few days is required? We responded to the above email last week Wednesday and I’ve had to follow up again this morning using Twitter and email for a response. The response we have received is still UNCLEAR? According to Discovery’s policy, as declared in their email, if the adoption is still not finalized, then we should receive full underwriting. Hannah’s adoption is NOT finalized, so why then are we being charged for the full month of April and not being covered by full underwriting as per THEIR policy detail??

Both Walter and I are getting seriously pissed off with the delay in response from Discovery, we want a clear answer, something which NO ONE at Discovery seems to be able to give us. The call center staff are CLUELESS when it comes to dealing with adoptions, their SM team managing the Twitter account seem to be the only ones who bother to respond, and even then mostly they just ignore me and fob me off with some lame response.

I feel we’re owed an explanation as to why we’re being shafted, up the rear with no lube? Again, I’d like to be clear, it is NOT about the R600 but about how nobody seems to be able to give us a clear answer to two things:

  1. How it’s not day light robbery that we’re being forced to pay for a full months cover when only a week’s cover was required?
  2. Why we’re not being offered free underwriting as Hannah’s adoption has not been finalized, as per their OWN policies?

Walter is so frustrated and angry that he is on the verge of cancelling our HP with Discover, even though we’ve been with them for more than 12 years and moving onto another scheme.

The response from their “Executive Relationship Manager” this morning was, in a nut shell, if you don’t like it then need to lodge a dispute. We still have not had a straight answer regarding the contradictory nature their policy!

Edited: So after another phone call from Discovery’s Executive Relationship Manager, which saw me explaining the new SA Child Act & why their policy is B.S. and I was answered with silence and had to check that she was in fact still on the line and then fed the message of policy, we’ve looked at our alternatives and Fedhealth comes out the winner. Better hospital plan, better cover, less adoption BS and an almost R7 000 saving per year. Cheers to you Discovery and your “policies”!

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17 Comments

  • Reply Ailsa Jean Porter

    I understand your anger, frustration and resentment. These big companies rip you off – try the ombudsman! It really isn’t fair!! And medical aids and insurances are the worst!!

    May 6, 2013 at 11:37 am
  • Reply Margot

    I have a similar bugbear with my out-of-the-ordinary child and Discovery. It seems a child with spina bifida does not qualify for extended benefits for allied health care (=Richie’s weekly physio session). So when the cash runs out for physio halfway through the year, we pay. We’ve queried this in a boring back and forth and just exist in a vicious circle – spina bifida is not one of the qualifyng conditions. Okay, so which ones are? These ones. But why them and not SB? It’s just not one of the qualifying conditions. Can we qyery thi? Yes, send a letter from doctor etc. We do it, then get feedback: I’m afraid SB is not one… Can you justify your decision? Back to the panel of doctors. Answer: (you’ll never guess this one): SB is not one of the qualifying conditions…

    May 6, 2013 at 11:42 am
    • Reply Sharon

      I hear you Margot! We’ve been having this argument with them for almost 3 weeks now… we can’t cover her from birth as it contravenes the SA Child Act and yet, Discovery’s policies require that we do exactly that.
      And I’d really like to know WHY they can’t charge us a pro rata amount? That seems fair, not a full month for 6 days cover surely?

      May 6, 2013 at 11:47 am
  • Reply Ms Quillin

    hellopeter.com their @sses!

    May 6, 2013 at 12:53 pm
  • Reply Melinda

    I would phone around for quotations for other medical aids. I was with discovery…changed to another medical aids hospital plan…for the three of us (with 400% gap cover), I only pay
    R 1928…which is much cheaper than Discovery. When I called them about adoption, their call agent could help me…dont know if there are any catches with adoption (have not got there yet)

    Discovery has grown so fast that they have become arrogant and forgotten about the people at ground level

    May 6, 2013 at 1:24 pm
  • Reply Paula

    Hi! I can sympathise with your problems, we had to bully Discovery a while ago on another type of issue which also demonstrated a complete lack of understanding. However I would advise you to reconsider changing for two reasons (this said from the perspective of a medical professional): first you are not going to find more intelligence elsewhere and second, despite the frustration Discovery is for various reasons still the best option despite being more expensive.

    May 6, 2013 at 4:37 pm
    • Reply Sharon

      We’ve received quotes from Fedhealth, a direct comparison between them and Discovery for the same hospital plan works out at R7 000 less per anum, more medical procedures covered and less exclusions. Fedhealth also include coverage of Hannah and Ava’s vaccinations even though its a hospital plan and not a medical aid. Discovery just can’t compete with that.

      May 6, 2013 at 7:29 pm
  • Reply Mrs FF

    So sorry about all the drama! Insurance is one of those pain in the butt things, can’t live with them can’t live without them. BTW, this non-prorata issue extends to adults as well, you can’t get cover except from the 1st of the month…. Crazy if you ask me. But I’m glad you’ve found a better option, it’s Discovery’s loss at the end of the day

    May 6, 2013 at 4:48 pm
    • Reply Sharon

      Yes I get the non prorata issue, but what annoys me is if I’d had a biological child, I’d have had a choice to either register them from birth or from a specific date and waste the money on a service I have not received. With an adopted child, their is no choice, no allowance for special circumstance made. I feel that their policy is outdated and with an adopted child, the date of placement should be treated in the same way as a biological child’s date of birth. ie: giving cover from date of birth/placement and not this BS of policy! Because their policy in effect excludes this option for adoptive parents because it is contradictory to the child act.

      May 6, 2013 at 7:27 pm
  • Reply Andrea

    Shocking! Definitely time to move on! We are so fed up with our policy at Momentum, covering far less of my pregnancy costs than officially anticipated, very frustrating 🙁

    Good luck x

    May 6, 2013 at 5:37 pm
  • Reply Julia

    How frustrating! I would be livid too! Hope you get it sorted ASAP. Actually, I hope you find a fantastic replacement for DH because I have not very good things about them for ages now.

    May 6, 2013 at 7:23 pm
  • Reply Kristin

    How absolutely maddening. I’m really sorry you had to go through this.

    May 7, 2013 at 4:05 am
  • Reply Kristi Fraser

    Discovery do not seem very understanding, unfortunately we are not all carbon copies, so there has to be some give on these policies. My baby brother who is 21, found out he had an extremely rare tumour, in order to do the scan,they required radio active isotopes, the scan costs R10000, but they refused to do the scan until he was booked into hospital for at least a week, which we found very funny as he was not very ill just had some symptoms but they would rather have the hospital charge them for a weeks stay + the scan then just the scan, beats me where they get their logic from.

    May 7, 2013 at 4:43 am
  • Reply Mash

    We’re with Genesis, and we will have to pay for an adult dependant until the adoption is finalised, but then they will refund us. I must say, I’m impressed with Genesis, cheaper, simpler and they do cover more.

    May 8, 2013 at 1:22 pm
  • Reply Pandora

    We had no oroblem adding L to our Momentum medical aid from the day we fetched her. However, we changed to Discovery later, after her name change and new birth certificate etc, and we still had to supply all proof of the adoption. I thought that was a bit much, because at that point I don’t think it is any more of their business. this obviously came about as she was on the old medical aid with her birth name.
    It does not end here, because we adopted, my daughter is not automaticaly eligible for my European citizenship! I have to apply for it, and jump through another hundred hoops. And all this despite the papers that clearly state ‘as if born to you’.

    May 8, 2013 at 3:49 pm
  • Reply Anon

    Oh Sharon, I hear you and completely agree these medical aids are full of it. I briefly worked for a medical aid in a snr mgmt position and didn’t last long as it felt like I was selling my soul in a morally corrupt industry. Medical aids are technically “Not for profit” companies (NPCs formerly s21 companies the same as charities) so they have no shareholders and are not taxed. Their main aim is to serve the public and not to make a profit. They have a board of trustees who CAN change rules / benefits of the scheme to better suit the public and they CAN look at individual cases and make decisions to overrule the normal policies and benefits. They should in the case of adoption, nothing stopping them. In reality they have admin companies who charge the medical aids big bucks and that’s how the owners get their profits out. I wish you luck with your new baby girl and family 🙂

    May 9, 2013 at 9:17 am
  • Reply Denise

    I understand your frustration. We have a dautghter in foster care. Our medical aid (Compcare) accepted her without any hesitation. She’s been with us since she was 3 months old. And I added her at about 9months of age. There was some exclusion that was placed on a waiting period but I had no troubles with them. We are now in the process of adopting her. The only requirement they asked for was a copy of the court order that stated that she was placed in our care.

    June 27, 2013 at 10:56 am
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