Two days ago I received final notices from PathCare with regards to two outstanding accounts, numbered EB817008 and EB827868, stemming from the premature birth of our baby daughter Jessica and her subsequent stay in the NICU at the Kuilsriver Medi-Clinic hospital. The services dates for the two accounts are marked as 19/11/2010 and 22/11/2010 respectively.
I have gone through my records with Discovery Health and cannot locate any reference to an unpaid claim made by PathCare (noted as Dietrich Bruce E Street And Partners according the Discovery records) with regards to EB817008, the one to the value of R164.00. This doesn’t make sense as any unpaid amount would reflect on the transaction history. I will need to see the claim details for this particular one before I settle the account, because at the moment I am beginning to believe that PathCare never even submitted this account to the medical aid in the first place! (Which would be completely unacceptable of course).
However, with regards to EB827868, valued at R671.70, I do have a transaction history from Discovery Health which clearly states (with a non-payment code of 4) that the reason this claim was not paid out was due to the claim not being submitted to them in time.
At this point I find myself becoming quite angry.
I have full hospital cover (Coastal Core) from Discovery Health, and as such my daughter’s month and a half stay in the NICU at Kuilsriver Medi-Clinic hospital cost the medical aid a LOT of money. PathCare itself made a number of claims during this period, all of which were paid out by the medical aid (to the value of R1390.50 according to the attached transaction history).
However, six months later, I now get a bill from PathCare saying that an account is due and I will be handed over to a Credit Bureau because Discovery didn’t pay, the reason being because they received the claim from YOUR accounts department too late?
That is completely unacceptable. How can I possibly be held responsible for the oversight, negligence or just plain incompetence of your accounts department? Surely it is PathCare’s prerogative to submit their claims to the medical aid in time?
I have attached the transaction history from Discovery with regards to “Dietrich Bruce E Street And Partners” for your perusal and have posted this message to both the supplied e-mail address at firstname.lastname@example.org as well on hellopeter.com in the hopes of opening up a line of communication with the necessary representative at PathCare who will be able to bring some clarity and hopefully resolve this unpleasant situation that I now find myself in.