Conflicting Information Regarding basic GP Network and Outstanding Chronic Medication Request

My husband has been a member of the medical aid for approximately a year and he recently attended his first doctor’s appointment at Medicross Table View Dr. Bruwer & Associates *** . I chose this practice because, when I checked the medical aid’s previous online system, Medicross Table View was listed as a network doctor/practice.

However the medical aid rejected the claim ***/D*** and when checking the new online system, I could no longer find the same information. This has resulted in confusion regarding whether the practice is still considered part of the network.

I have contacted the medical aid twice and received two completely different explanations:

1. Call on 24 August During my first call, the consultant advised me that Medicross Table View should definitely be covered and that she would resubmit the claim/request because they cover that doctor. I was not provided with a reference number, nor did I receive the promised feedback via email.

2. Call on 31 August – I contacted the medical aid again because I had still received no feedback. This consultant provided a completely different explanation and advised me that it is the doctor’s practice that adds or removes the practice from the medical aid’s network list. I requested an email confirming the information discussed during this call, including the reference/details of the query, but I have still not received this email.

This leaves me with a very serious concern:

Am I now expected to check the medical aid’s network list every time my we need to see a GP, simply to determine whether that particular doctor/practice is still on the network list this week?

If practices can be added or removed from the network without members being clearly informed, this places an unreasonable burden on members. It could also result in members choosing a doctor based on information previously provided by the medical aid, only to later discover that the doctor is no longer considered a network provider.

I am extremely disappointed with the conflicting information I have received and the lack of communication regarding my queries.

Chronic Medication

I would also like to raise a separate concern regarding my husband’s chronic medication.

His doctor’s office contacted the medical aid to have his medication registered/approved as chronic medication. We were advised that I needed to request a specific form from the medical aid.

I contacted the medical aid and requested the form. I was then advised that I needed to submit the prescription instead. I followed these instructions and submitted the prescription, but I have still received no feedback regarding the outcome. The query/reference number for this matter is: ***

I also sent an email to the medical aid on 24 August and have received no response. The query number is: 334770

I find it extremely frustrating that I have followed every instruction given to me, yet I am still left without clear answers or feedback.

I am requesting the following: Written confirmation of whether Medicross Table View and the specific doctor my husband consulted are/were part of the relevant network, including the applicable date. A clear explanation of why I received two different explanations from your consultants. Confirmation of what members are expected to do if network doctors/practices change. Feedback on the outstanding consultation/claim and confirmation that it will be processed according to the correct benefits. An urgent update on my husband’s chronic medication application, relating to query ***.

A written explanation of the correct process for registering chronic medication so that I do not continue receiving conflicting instructions.

I have been a member and have tried to follow the correct processes, but this experience has been extremely disappointing. I should not have to make multiple calls and receive different answers simply to establish what my medical aid covers.

I would appreciate a formal written response to this complaint, including clear answers to all of the above questions and confirmation of the steps that will be taken to resolve these matters.

I look forward to your urgent response.

Kind regards, Caylyn