1 reviews | Active since Jan 2012
Rejected claims
I had chest pains on the 6 March and I was also struggling to Breath, it was around 1 am in the morning , my wife drove me to waterfall hospital in woodmead, being an emergency a nurse called one of the Doctors who examined me.<br> I was discharged after 3 hours after bloods tests and Xtrays. to cut a long story short after couple of days I received claims that camaf rejected, apparently in that pain Camaf expected me to question the doctor examining me if she was a Network doctor or not that's according to a Camaf Consultant I phoned earlier and if the doctor said no what was going to happen to me, is that really practical that in my pain I will have time to question whether doctors are part of network choice.<br> <br> Apparently the Doctor that attended to me is not part of Network choice and I am responsible for all paymenst<br> <br> I find this really unfair considering that I pay thousands and thousands of rands every month to Camaf.<br> <br> My Camaf number is ***4 if they are interested in attending to my complaint
Hello Ntsahwe12
Your elected option is Network Choice which is a capitated option. All treatment on this option is covered at Network providers. Camaf does allow one out of area network visit which could be used for casualty, however the option protocols will still apply i.e. xrays and blood test are only covered as per protocol and subject to referral by a Network provider. CAMAF has stipulated this in the brochure for all members to fami****ise themselves prior to selecting this option. These claims will only be covered if the patient is admitted to hospital. Regrettably in your case you were not admitted and therefore these claims remain your responsibility.
We trust that this clarifies your benefits. Should you need any further assistance please do not hesitate to contact us.
Kind regards
Alicia Dalais
Client Relations Manager
Best regards,
Hello Ntsahwe12
Your elected option is Network Choice which is a capitated option. All treatment on this option is covered at Network providers. Camaf does allow one out of area network visit which could be used for casualty, however the option protocols will still apply i.e. xrays and blood test are only covered as per protocol and subject to referral by a Network provider. CAMAF has stipulated this in the brochure for all members to fami****ise themselves prior to selecting this option. These claims will only be covered if the patient is admitted to hospital. Regrettably in your case you were not admitted and therefore these claims remain your responsibility.
We trust that this clarifies your benefits. Should you need any further assistance please do not hesitate to contact us.
Kind regards
Alicia Dalais
Client Relations Manager
Best regards,