Topmed Medical Scheme Complaint
 SUPPLIER |
Topmed Medical Scheme |
 INDUSTRY |
Medical Aid |
| BRANCH / AREA | ALL | COUNTRY | South Africa |
| TIME / DATE | 09:54 Tue 8 Nov | PERSON RESPONSIBLE | EVERYONE!!!!!! |
| CUSTOMER | 121girl | View all reports by user |
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15
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| PROBLEM | Breach of Contract |
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| INCIDENT | Tue 8 Nov | ||
| HEADLINE | LIVID AT THE MATERNITY PROGRAM and the ****!!! |
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| I took out the most expensive plan from Top Med and enrolled for the Marenity Program. I was told that i will be covered for 12 Antenatal visits, 2 out of hospital scan, vitamins and ante natal classes. I went to the Dr for my fist 2 visits and was told the medical aid covered it in full as it fell inside the 12 visits. 2 months later I receive a bill of just under R900 from my Dr saying the medical aid is paying me instead of them. I contact the medical aid and they tell me they only pay for 100% of the tarrif, the amount of R257.50. Leaving me to pay the DR. NOWHERE in the ENTIRE booklet, or ANYWHERE on the site does it say 100%TT like every OTHER benefit. I made use of 1 of the 2 out of hospital scans and I needed to pay upfront R800 for the scan and claim it back. I submitted the claim on the same day, and the amount was processes today taking the R750 out of my savings which has now depleted my savings!!! WHY THE H*LL do you explain that these special MATERNITY benetifs DO NOT COME FROM SAVINGS IF THEY DO!!!!!!????? I am so LIVID at the fact that I listened to you people and took out this plan! WHATS NEXT??? How do I know for SURE THAT THE BIRTH WILL BE COVERED IN FULL? | |||
| SUPPLIER'S RESPONSE | Topmed Medical Scheme | Time and Date | 10:03:09 | Tue 8 Nov 11 |
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Hello 121girl, Thank you for bringing this to our attention. Kindly note that we are looking into your concerns noted and will provide you with feedback shortly. Kind Regards Lindiwe Mpanza (Ms) |
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| UPDATED RESPONSE | Topmed Medical Scheme | Time and Date | 16:50:28 | Wed 16 Nov 11 |
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Hello 121girl, We wish to apologise for the delay in responding and the inconvenience this may have caused. Kindly note that the amount of R257.50 was paid towards a consultation of R400.00, which was for the date of service 13/10/2011. The amount of R845.10 claimed, was for dates 13/10/2011 and 16/09/2011. The scheme paid R560.10, as the provider charged above the Topmed Tariff, for consultations.As per the benefit guide, for Maternity Programme, it states the following: "Benefits as described in respect of medical practitioners and hospitalisation", which is reflected in Part 2 of the benefit guide. Please note that if your provider claims for a certain code that is not on your maternity authorisation, that particular code will not be covered, therefore the claim will map to your day today benefits. Hence the tariff code 3637,for date of service 28/10/2011, was paid from your savings. All benefits are covered at a certain percentage, of the medical aid rate, in other words, the scheme will only pay the full amount, if the provider has charged within the medical aid rates, subject to funds available. Confinement is also subject to medical aid rates. Kind regards Lindiwe Mpanza (Ms) |
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| CUSTOMER'S FEEDBACK | 121girl | Time and Date | 15:57:21 | Wed 16 Nov 11 |
| Utterly Disgusted: NO ONE HAS CONTACTED ME BACK AND THIS WAS 8 DAYS AGO!! I HAVE TO PAY THE R45 PER MONTH FOR MY"ACCOUNT MANAGER" TO DO MY CLAIMS AND YET HE CANT EVEN RESPOND TO MY EMAILS. I CALL AND HE IS ALWAYS "OUT OF OFFICE" LOOKING FORWARD TO CANCELLING ONCE MY CHILD IS BORN AND GOING WITH A COMPANY WHO ACTUALLY DOES WHAT THEY PROMISE!! OVER 2K A MONTH FOR WHAT??? I TOOK OUT THE COVER SO MY PREGNANCY COULD BE STRESS FREE AND NOW IM MORE STRESSED BECUASE IM NOT CERTAIN ABOUT WHAT ELSE IS GOING TO HAPPEN!!!! | |||
Relevant content (Last 5 Breach of Contract Problems)
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