AM
Andries M

1 reviews | Active since Mar 2009

21 Feb 2019, 14:59

Account being rejected that should be paid and I am being send back and forth

I've been up and down with the call center to try and pay an account that was declined for payment. I was told that ICD10 code used was incorrect and that the correct code must be submitted. The Physio in question then send me an account showing the same ICD10 codes used on a prior account that the medical aid paid and remembering now I realised that it was a fight to get it paid. Now after telling the call center agent that the ICD10 code is correct, Im being told that it does not matter what the code is because the Dr's account should reflect the correct ICD10 code before any other accounts will be paid. Calling the Dr's rooms, I was told that I must contact the Hospital in question as the Dr's accounts are submitted from the hospital. Im fedup with the back and forth....The latest is that the ICD10 code used was not a PMB yet the hospital take out drugs (that was also not paid initially and had to be asked to be re-processed as is always the case) was paid and according to the medical aid documents, take out drugs is only paid for PMB conditions...Therefore the hospital ICD10 codes must be PMB related then why are the Physio accounts not being paid. I hate doing this but I feel I have no other choice in order to get to someone that is willing to look at the actual problem and fix it in order to pay the physio as they should be paid.

0
Replies (3)
Bankmed
Bankmed's reply21 Feb 2019, 17:36
Official
Hi Andries, thanks for speaking to us and allowing us to investigate the details of your claim query. Apologies again for any inconvenience caused. We'll be in touch with the feedback regarding the outcome of the investigation as discussed. Have a great day further. 

Regards,
Bankmed Service Team
AM
Andries M's update04 Mar 2019, 09:36
Reviewer Update
Good day. Thank you for your response. I was contacted on 21 Feb with a promised that the matter will be investigated and feedback will be given. Its been 11 days since and no further communication was received? Please can someone contact me with the outcome....I'm sure you could have established what the problem is by now?
Bankmed
Bankmed's reply04 Mar 2019, 17:05
Official
Hi Andries

Please accept our sincere apologies for the delay. 

We will follow up on this matter and provide you with an update regarding the processing of your claim.

Regards,
The Bankmed Service Team.