Medihelp Complaint

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SUPPLIER	Medihelp	INDUSTRY	Medical Aid
BRANCH / AREA	Gauteng	COUNTRY	South Africa
TIME / DATE	15:18 Fri 27 Jan	PERSON RESPONSIBLE
CUSTOMER	ils250	View all reports by user	0 1
PROBLEM	Unclear on Emergency C...	Post this report to your Facebook page Post this report to your Twitter page
INCIDENT	Fri 27 Jan
HEADLINE	Medihelp Necesse - Do not cover Emergency
I am shocked to find out that Medihelp Necesse doesn't cover a member for Emergency visits. They say that you have Unlimited 100% cover in PMB, untill you go through an emergency and do your member duties by reporting it to them within 72hrs, just to find out that your case is not a PMB --- SHOCKING!! The consultant could not give me a list of PMBs, they assess it themselves... what nonsense. Who is the consultant to say what is an emergency. I am still sitting in pain. I went to emergency during the night for pain in my abdomen, they suspected appendicitis and then sent me for tests to confirm what the cause of the pain is.The annual booklet does not mention any detailed information wrt what is considered an emergency PMB. This I believe is not acceptable and misleading due to the fact that your website and booklet is a primary source of information used when potential members consider Medihelp Necesse as their Medical Aid. I am appauled that Emergency cover on this plan only offer R740 per year, and do not cover any Tests within the emergency situation. I have been a Medihelp member for 3 years and feel like this plan is not for member benefit. What's medical aid especially for? Add a new Medihelp Report Inappropriate report?
SUPPLIER'S RESPONSE	Medihelp	Time and Date	07:21:49 \| Mon 30 Jan 12
Hello ils250, 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
UPDATED RESPONSE	Medihelp	Time and Date	11:28:10 \| Fri 3 Feb 12
Hello ils250, The information pertaining to the authorisation of your emergency visit to Dr Meltzer on 27 January 2012 was received within the prescribed period of 72 hours following the incident, as required in terms of the Medihelp Rules. However, these services do not qualify for Prescribed Minimum Benefits (PMB) according to Medihelp's protocols. Medihelp requested an ICD-10 code from the service provider, to determine whether the event qualified for PMB, but as no ICD-10 code was received; the services were paid from your out-of-network benefits limit instead. Please note that a 20% co-payment is payable by you, in the event of emergency and out-of-network consultations that do not qualify for PMB. Kind regards Medihelp Customer Care
CUSTOMER'S FEEDBACK	ils250	Time and Date	12:56:08 \| Fri 3 Feb 12
Indifferent: Thanks for the response. I however feel strongly that Medihelp needs to make these critical issues (loop holes) clearer when it comes to Emergency cover on their policy documents. This unfortunately has resulted in me looking for (and finding) a Medical Aid that offers full emergency cover.