Discovery Health - Vitality & Team Vitality plus everything else you need to know

[Captain Fastbastard Mayhem]

Not moaning about points allocation, just that they are not allocating points I earned.

 

No Miles. They deliberately try avoid paying out on medical. Just like they don't allocate points on VAR.

 

I had a crash. Covered the hospital except for R158 for an ice pack used post surgery in hospital for swelling. Petty.

 

I applied for a PMB for physio. Applied for 20 sessions. Approved 12. I've had 28 sessions till today and need ongoing treatment. Although they approved the PMB, they have rejected every bill as submitted by the physio. They have been submitted EXACTLY as approved. So the physio has not been paid since March 12 by Disco despite the approvals given and I've had to pay to continue the treatment.

 

All the best doctors have opted out of Disco so the medical aid covers between a third to a half of the cost of an operation.

 

None of this bothered me until they did not allocat points for 3 workouts and I've thought about my relationship with them. Now I'm irritated.

 

I don't know the merits of your case, or the specific PMB requirements / coverage for that particular event, but I'm willing to bet that the PMB allocation for physio for that event is 12 sessions - not 20. And on PMB, they are BRUTAL in their adherence to terms and conditions. Any physio treatment is normally paid from MSA, so once those 12 had run out you would have been dipping into savings pretty darn fast. 

 

As for the ice pack - again, not sure, but it probably didn't have a NAPPI code, or wasn't submitted correctly, or something went wrong. But if it was as part of your hospital admission it should have been paid, unless it was one of those things that the doctor / hospital pushes through when it isn't necessary - there's a lot more of that than you may think. I'll agree that it's petty, but 1,000 petty items all add up to us being charged more. 

 

As for the "doctors opting out" - absolute twaddle. Specialists that were part of the Disco direct payment arrangement were contracted to charge a factor of the Discovery Health Rate, as set by Disco, to reduce their overheads and unpaid bills (under the guise that they'd have more certainty of payment and thus have to spend less time on following up on non-paying clients) - there are now MORE specialists on these payment arrangements than there were 2 years ago. There may be (are) doctors leaving and joining the payment arrangement, but only because they either want to charge more than Disco will cover through the arrangement, or the numbers don't work for them. 

 

Also - ALL specialists charge a multiple of the Discovery Health Rate, Momentum Health Rate, Fedhealth Rate and so on. All the med aid rates were loosely based on the now "illegal" NHRPL (national health reference price list) which USED to set an "acceptable" rate for pretty much every single item and procedure code in the medical fraternity, but now all the med aids set their own rates based on their buying power and negotiation power (momentum and disco both hold significant clout in driving down the cost of medical implements)

 

Specialists routinely charge between 300% & 500% of "medical aid rates" - this does not change depending on which med aid you belong to, and they (specialists) can charge what they want. This is a problem you will find at any med aid, as even the top tier med aids only ever cover at 300% of the med aid rate - so even on the Executive plan (Disco's crazily expensive top tier plan) you won't have as much cover for specialists in hospital as you'd have with a coastal saver & gap cover combo. 

 

I'm not doubting your experience at all, it's just that you have most probably been spun a yarn or 2 from somewhere, and are placing the blame squarely at Discovery's feet as a result of a bit of misinformation being pushed your way. I'm also not saying that you haven't fought them - for a claim to go smoothly, every single bit of info needs to be in the right place, at the right time, and done pristinely. Do you know if the physio has used the right ICD10 code for the work that he's doing, so that the sessions can be paid from the PMB benefit before shafting your savings? There are ICD10 codes that are to be used specifically for a PMB benefit. 

 

Also - it seems like you need to get a claims manager to talk to, in order to get the treatment you've been promised. Unfortunately, and I've seen this personally, sometimes it's the idiot behind the computer that doesn't put 2 & 2 together when receiving a statement or invoice from a hospital / service provider. Then the OTHER idiot who made the invoice up in the first place insists that they were right all along and it couldn't possibly have been their fault that they weren't paid... 

 

Through personal experience and handling claims, It's an admin nightmare trying to get the doctors rooms to submit the RIGHT paperwork, with the correct ICD10 codes with cogent motivations as to WHY they're doing something. Then to submit and follow up and and and. For a PMB event, it's even more time consuming and hair pulling. So much so that we have 2 employees in a 6 person practice (2 1/2 advisors - half because she's not actively practicing) that are solely devoted to dealing with med aids & gap cover and claims...  

Edited June 22, 2016 by Myles Mayhew

[jcza]

I sent them screenshots of my activity from Sat that didn't get points.

Sent 4 in total off the Garmin Connect website, showing all the info they would need.

receive this today:

 

Please note that we are unable to assist with the screenshot provided as it does not have all the information required for us to be able to investigate your workouts. The screenshot has no date.

Ensure that the screenshot includes the following:

• Date
• Type of event
• Duration
• Heart rate, speed, distance, steps etc.

Maybe if I draw big red circles around the details on the screenshots they'll see them better?

 

I found when sending screenshot of webpage it says Sunday or yesterday instead of date. Do a screenshot from Garmin Connect app and send that in. Just make sure your heart rate data is visible.

[carbon29er]

 

Believe what you will Myles. There is no misinformation being fed to me. I go to A&E involuntarily and need the best surgeon. He charges what he wants and I know I'm not covered for his full fees. But I choose him because he's the best, not some guy who accepts a third of the good guy's rate because it's my shoulder and I want it fixed properly.

 

But to reject R158 on a bill of over R100k. Just silly. A screw used in my shoulder cost R 4027.4 another R3,221.92 and a few R805. They were used because the surgeon said so. He also said I need an ice pack.

 

On the PMB, I personally have spent time on the phone to Disco, logged 2 separate queries, sat with the accounts department at the physio, watched the submission and received the rejection. Now, as a CA I'd reckon I would understand the submission process in terms of the PMB. But no. The delay in payments is just petty.  They owe the money, they are just trying to weasel out of paying.

 

As for the PMB, I'm entitled to a repair for a complex shoulder injury that involves the clavicle, scapula and glenoid. I get a PMB just for the clavicle. Because they do not want to pay.

 

Same thing with not syncing workouts done. Not even raising the issue of getting people to commit to watches then changing the points allocation system because they can ito the fine print. When they stop allocating points for legal workouts what hope is there?

 

I'm surprised you can't see the behavioural link on the part of the 5 companies within the Discovery platform.  Promise and contract to something then don't deliver.

 

Do I want to risk the future of my children and their education in the event of my death to this risk?

[carbon29er]

We are starting to see eye to eye..........

Not really....

[Captain Fastbastard Mayhem]

Believe what you will Myles. There is no misinformation being fed to me. I go to A&E involuntarily and need the best surgeon. He charges what he wants and I know I'm not covered for his full fees. But I choose him because he's the best, not some guy who accepts a third of the good guy's rate because it's my shoulder and I want it fixed properly.

 

But to reject R158 on a bill of over R100k. Just silly. A screw used in my shoulder cost R 4027.4 another R3,221.92 and a few R805. They were used because the surgeon said so. He also said I need an ice pack.

 

On the PMB, I personally have spent time on the phone to Disco, logged 2 separate queries, sat with the accounts department at the physio, watched the submission and received the rejection. Now, as a CA I'd reckon I would understand the submission process in terms of the PMB. But no. The delay in payments is just petty.  They owe the money, they are just trying to weasel out of paying.

 

As for the PMB, I'm entitled to a repair for a complex shoulder injury that involves the clavicle, scapula and glenoid. I get a PMB just for the clavicle. Because they do not want to pay.

 

Same thing with not syncing workouts done. Not even raising the issue of getting people to commit to watches then changing the points allocation system because they can ito the fine print. When they stop allocating points for legal workouts what hope is there?

 

I'm surprised you can't see the behavioural link on the part of the 5 companies within the Discovery platform.  Promise and contract to something then don't deliver.

 

Do I want to risk the future of my children and their education in the event of my death to this risk?

Eish. Not cool, Rob.

 

I have to ask, though - where is your broker in this? It's difficult cases like this that I would get involved in... There's a reason beyond "they don't want to pay" and you are entitled to know that reason. 

 

As for the syncing - again, I'm pretty darn sure that the system / relationship / process of syncing is inherently more complex than it seems from the outside. 

[Eugene Brown]

I've been with Discovery forever it seems, and have never really worked the system of "integration", with all the benefits, until this year. A couple of points short of gold, good paybacks coming every month, 30000 fitness points, all the assessments, etc. everything great! In all my slack years, though, I never got injured badly.

Now I've put in the effort, I bliksem off and break my hip! I hope that isn't a precursor to the rest of me living the Disco/Vitality life 

On a serious note, yes, I've had a few gripes with them, but on balance, they do a fairly good job on the medical aid/insurance front. My complete hospital bill of +R75K for my hip was paid in full, except for crutches and compression stockings. That was not Disco's fault, the physio practice only submitted their account 2 weeks after I'd left the hospital. I'm sure it will be sorted with time....

Their support isn't where it should be, their call centres frustrate the sh%t out of me, their walk-in centres are only slightly better, their products are complex to fully understand, etc. etc. but who else in their industry/ies offers you the convenience of a "one-stop-shop"?

Love them or hate them, they're doing something right

[Jigghead]

 

...I have to ask, though - where is your broker in this? It's difficult cases like this that I would get involved in... There's a reason beyond "they don't want to pay" and you are entitled to know that reason. 

 

...

The broker is key in these cases. In my time with Discovery, as an independent, I managed to have experimental and at that time unproved medical treatment paid for on behalf of one of my clients. It took around two or three months of research on my part(I now know almost all there is to know about Rheumatoid Arthritis), but not only did they pay but now include it as an approved treatment @ R75K a shot, in this case administered every three months. I also managed to have a disability claim paid by discovery for a disability that occurred in Iraq, when Iraq was specifically excluded. 

 

The broker does not work for the insurer, he works for the client and as a result, should fight for the client no matter what. The bottom line is, as I mentioned before, get your broker to earn his income, all insurers are open to paying for treatment and other claims if it is properly justified, and that justification should be pushed by the broker!!! 

[Captain Fastbastard Mayhem]

The broker is key in these cases. In my time with Discovery, as an independent, I managed to have experimental and at that time unproved medical treatment paid for on behalf of one of my clients. It took around two or three months of research on my part(I now know almost all there is to know about Rheumatoid Arthritis), but not only did they pay but now include it as an approved treatment @ R75K a shot, in this case administered every three months. I also managed to have a disability claim paid by discovery for a disability that occurred in Iraq, when Iraq was specifically excluded. 

 

The broker does not work for the insurer, he works for the client and as a result, should fight for the client no matter what. The bottom line is, as I mentioned before, get your broker to earn his income, all insurers are open to paying for treatment and other claims if it is properly justified, and that justification should be pushed by the broker!!! 

THIS. Always, this. 

 

In this case, even though I have a different opinion of what may have occurred to get to the no claim side of things, I'd continue to fight for an approval and adherence to their end of the T's & C's/ 

[Frosty]

Got this in a reply from my Mom.

 

Phoning seems to be the best way (in March I emailed and had no resolution although they said I got the points)

 

· You get a reference number

 

· Then you email to fitnessdevices@discovery.co.za :

 

· Subject line must reflect reference number, Vitality number and your name

 

· In body of email - screen shot of Garmin being linked to Vitality

 

· In body of email - screen shot of activity on Garmin site

 

· In body of email – screen shot of Vitality Points Monitor so they can see it is not recorded

 

What isn't mentioned is the date (or lack thereof). Hope this helps.

[Jigghead]

THIS. Always, this. 

 

In this case, even though I have a different opinion of what may have occurred to get to the no claim side of things, I'd continue to fight for an approval and adherence to their end of the T's & C's/ 

 

Myles, my approach was always to get them to pay unless they offered a viable reason as to why the doctor's advice on treatment was wrong, which was to have been communicated to the client. In the case of the Iraq disability, I got the client to agree to have the additional premium that would have been charged in the event of cover in Iraq deducted from the claim amount paid. Client first, this was a 23 year old guy who was left paralysed as a result of a sand storm.

 

I need to sleep at night and it would have been hard if I had not tried everything within my power to make it happen!

[Captain Fastbastard Mayhem]

Myles, my approach was always to get them to pay unless they offered a viable reason as to why the doctor's advice on treatment was wrong, which was to have been communicated to the client. In the case of the Iraq disability, I got the client to agree to have the additional premium that would have been charged in the event of cover in Iraq deducted from the claim amount paid. Client first, this was a 23 year old guy who was left paralysed as a result of a sand storm.

 

I need to sleep at night and it would have been hard if I had not tried everything within my power to make it happen!

bold: Yep. I use that as well.

 

Underlined: Yep. Used that, too. That's standard practice though, even in the case of smoking - if you "forget" to tell them (any insurer) your additional premium would be deducted from the payout in the case of a claim

 

the loading is essentially a geographical one. Very different to saying you're 100% admin and you actually drive a delivery van, and have a claim denied on that end (where occupational disability cover is not available)

Edited June 22, 2016 by Myles Mayhew

[mudda]

Hi,

 

I am not sure if this has been covered before, but

 

why are ashburton and trailseeker events not available for claiming vitality points ?

 

https://www.discovery.co.za/discovery_coza/web/linked_content/pdfs/vitality/team_vitality/vitality_race_events_calendar.pdf

 

surely saseeding results can be used ?

[nathrix]

Fortunately I have achieved the weekly goal already so that I don't pay back da money, but received only 100 points (which only reflected now for some reason after a bit of a delay) for "Taking 10 000 or more steps" when it was clearly a cycling workout on 21 June 2016...Discovery is awesome (I'm doing a kumbaya dance behind my keyboard).

[nonky]

Hi,

 

I am not sure if this has been covered before, but

 

why are ashburton and trailseeker events not available for claiming vitality points ?

 

https://www.discovery.co.za/discovery_coza/web/linked_content/pdfs/vitality/team_vitality/vitality_race_events_calendar.pdf

 

surely saseeding results can be used ?

 

 

Why are there fewer race events that members can claim points for and how can I still achieve my Vitality Active Rewards goals?

We are moving towards only awarding members' points where the data has been verified by a timing company that has integrated with us. By receiving data from the timing company, we receive proof that the member completed the event. The number of races that we award points for depends on the timing companies that integrate with us. 

[mudda]

 

Why are there fewer race events that members can claim points for and how can I still achieve my Vitality Active Rewards goals?

We are moving towards only awarding members' points where the data has been verified by a timing company that has integrated with us. By receiving data from the timing company, we receive proof that the member completed the event. The number of races that we award points for depends on the timing companies that integrate with us. 

 

 

I will try follow up with discovery  and see if they can integrate with saseeding ... that would allow the auto point allocation ...

 

Or has it been tried before and failed  ?

[Bub Marley]

I've been inactive for 3 weeks now and my target hasn't decreased at all. Curious to see what happens on saturday when I miss out again.