Medihelp Complaint
 SUPPLIER |
Medihelp |
 INDUSTRY |
Medical Aid |
| BRANCH / AREA | Johannesburg | COUNTRY | South Africa |
| TIME / DATE | 15:58 Tue 31 Jan | PERSON RESPONSIBLE | Multiple |
| CUSTOMER | maroute | View all reports by user |
 0
4
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| PROBLEM | Billing / Accounts |
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| INCIDENT | Fri 5 Aug | ||
| HEADLINE | 5 months and claim still not processed |
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Almost 6 months ago now, I delivered my baby with the assistance of a midwife. I submitted my claim, which was authorised months before. Medihelp has been delaying the process for months now. First it was a problem with the dates, then with the code, then with the authorisation number. I have been calling them evevy 2 weeks to try to get an answer as my Top Up cover needs a statement from them before 6 months from the date of treatment which will be on the 5th of Feb. The only answer I get is that it's busy been processed!!!! It's incredibly frustrating and I am going to lose on my Top Up cover because of their inefficiency! One person (Nicky) has been helpful, but since then nothing.... Marie Elefteriou (Membership 6054544, account for Sr Sharon Marsay 5th of August) |
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| SUPPLIER'S RESPONSE | Medihelp | Time and Date | 08:08:18 | Wed 1 Feb 12 |
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Hello maroute, Thank you for writing to us. Your complaint was referred to our client service department for investigation and a consultant will contact you in this regard. Kind regards Medihelp Customer Care |
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| UPDATED RESPONSE | Medihelp | Time and Date | 10:56:14 | Thu 15 Mar 12 |
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Hello maroute, Medihelp initially received the account of Ms Marsay on 16 August in respect of services rendered on 5 August, where after the claim was rejected on 9 December with a message stipulating that the services was not pre-authorised. Upon receipt of your telephone enquiry on 3 January, it was established that the service provider erroneously billed procedure code 88403 (global obstetric fee - home birth) instead of procedure code 88399 (global midwife delivery fee in hospital/birthing unit) as originally pre-authorised by the Scheme. Ms Marsay was thereafter requested to furnish Medihelp with an amended account, which was received on 6 February and reprocessed on 7 February. An amount of R2,031.40 was paid to Ms Marsay on 12 March and the outstanding amount of R3,968.60 will remain your responsibility as the amount claimed exceeded the approved amount combined with the fact that Ms Marsay claims tariffs more than the scheme tariff. Medihelp would like to offer its sincerest apology for the delay in payment of the account in question and for any inconvenience or frustration you may have suffered as a result thereof. Kind regards Medihelp Customer Care |
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| CUSTOMER'S FEEDBACK | maroute | Time and Date | 11:40:10 | Fri 2 Mar 12 |
| Not Impressed: Claim was reprocessed as mentionned, but came back to me stating that the service was not authorised, when it had been 6 months prior. I am again fighting with them, waiting for feedback!!!!! I am waiting for this claim to be finalised to change my Medical Aid provider... absolutely ridiculous! | |||
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