How do I submit a claim for payment?
If your healthcare professional has already sent us your claim, you don't need to send us another copy.
If your healthcare professional asks you to send the claims, please make sure that you send us the detailed, original claim and not just a receipt. We need all the information about your claim to process it.
Make sure the following is included in your claim:
- Your membership number
- Details of your healthcare professional and practice number
- Name of patient
- Relevant consultations, procedure or Nappi code and diagnostic (ICD-10) codes
- Amounts charged
- The receipt for any claim you already paid
You can send us your claim by:
- Uploading your claim through the website or app. Upload now?
- Emailing it to claims@discovery.co.za.
You must submit your claims within four months. After four months, we'll consider them expired and will not pay for them
What happens after I submit a claim?
If we get your claim electronically, we will send you an email with a reference number telling you that we've received it. Claims are normally processed within two to three working days.
You can track the progress of your claims by using the Claims Search tool. This is a useful tool to check which of your claims have been paid and which are still being processed.
Why didn't you pay all or part of my claim?
We pay claims according to your available benefits. Once we pay the claim, we send you a claims notification email showing the claim, what we paid, from which benefit we paid, who we paid and for what we didn't pay. If you have to pay anything yourself, we add a 'reason code' to the statement. This code gives you more information about why we didn't pay your claim.
Who gets paid?
If your healthcare provider charges for the service at the Scheme Rate, the claim will be paid into their bank account.
If your healthcare provider charges a higher rate than the Scheme Rate, you will be refunded for the claim. You must pay the healthcare provider if you have not already done so.
If you have paid for the claim, we will pay the refund into your chosen bank account. You must attach your proof of payment if you want us to pay you back. This can take four to six working days.