Medihelp Complaint
 SUPPLIER |
Medihelp |
 INDUSTRY |
Medical Aid |
| BRANCH / AREA | Head Office | COUNTRY | South Africa |
| TIME / DATE | 16:08 Wed 25 Jan | PERSON RESPONSIBLE | Medihelp Claims / Pre... |
| CUSTOMER | sanema | View all reports by user |
 0
1
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| PROBLEM | MEDICAL BILLS NOT PAID |
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| INCIDENT | Wed 25 Jan | ||
| HEADLINE | Medical Bills Shortpaid |
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With Reference to the Membership of Elmarie Stemmet, Member 5831938, and the authorisation requested for the operation for Thomas Francois Theodore Stemmet, the following: On the 6th of December 2011 I sent the detailed quote and ICD codes to Medihelp in order to obtain Authorisation for the procedure that had to be performed on Thomas Theodore Stemmet. An Authorisation number was provided by sms to ourselves and directly to Doctor and Thomas subsequently had the surgery. We have now received a statement update from Medihelp that they are only paying in the region of R3400 on a total bill in excess of R11000.00 There was no communication from Medihelp that the quote submitted was no accepted or no indication that they would only pay such a limited amount of the costs that were outlined. The allocation of the Authorisation number left the impression that the procedure as a whole was approved by Medihelp, especially as it included the full quotation of the doctor. I therefore find it completely unacceptable that you have blindsided us by, without submitting any type of correspondence ahead or after the procedure, indicating that we are responsible for the balance of the amount. |
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| SUPPLIER'S RESPONSE | Medihelp | Time and Date | 07:38:26 | Thu 26 Jan 12 |
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Hello sanema, 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 | 14:13:26 | Fri 3 Feb 12 |
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Hello sanema, As telephonically discussed on 31 January 2012, Medihelp confirmed that you had no record of the telephone conversation between yourself and MSO as referred to in your complaint, to enable the Scheme to investigate your enquiry. Payment in respect of these services was made to Dr Kleintjies on 10 January 2012 according to the Medihelp Rules. As you were aware of the fact that Dr Kleintjies was intended to charged 300% more than the scheme tariff, the difference will remain your responsibility. It is therefore advisable to contact Dr Kleintjies in this regard, to make arrangements for the settlement of the outstanding amount. Kind regards Medihelp Customer Care |
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| CUSTOMER'S FEEDBACK | sanema | Time and Date | 08:59:28 | Tue 31 Jan 12 |
| Utterly Disgusted: This is unacceptable. Upon receiving the SMS authorisation code, I phoned Medihelp to specifically enquire whether the procedure as a whole had been approved and the consultant indicated that this was the case and that we only had to pay in a R950 co-payment at the hospital. Why did your consultant then not inform us of the fact that they would not even cover a proper third of the costs? I specifically phoned to check on this. I will be referring this to the CMS for review | |||
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