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Paul M

1 reviews | Active since Oct 2017

11 Sept 2018, 12:28

Thieving "Medical Aid" who refuses to pay for medical aid

I injured myself at CrossFit. Knowing I needed physiotherapy, I went to see a physio who submitted the claims to CAMAF as I have a physio/chiropractor benefit.

CAMAF refused to pay for the claim because I didn't go to a GP to get a referral to a physio. CAMAF doesn't seem to understand that it is not necessary to pay a GP R600 for them to just tell you to go to a physio (something you already know).

Audit trainees do not earn a lot of money so that fact that it is a requirement to pay a doctor simply for a referral, ON THE CHEAPEST MEDICAL AID OPTION no less, makes no sense whatsoever.

CAMAF is honestly the worst "medical aid" and will never support you when you need it. If you have the choice, do not get "medical aid" through CAMAF as no aid will be forthcoming.

I am just thankful that I only have to be on this thieving "medical aid" for one more year.

Furthermore, I will be lodging a complaint with the ombudsman because your requirements to qualify for claims are so cost-prohibitive that people like me can never afford to qualify for your help DESPITE PAYING OUR MONTHLY PREMIUMS TO YOU (premiums you are more than happy to accept).

I literally can't say enough negative things about CAMAF. DO NOT SIGN UP WITH CAMAF!!!

0
Replies (8)
Camaf
Camaf's reply11 Sept 2018, 15:07
Official

Good day Paul

Thank you for bringing this matter to our attention.

Please allow us an opportunity to investigate this matter further and we will provide you with feedback as a matter of urgency.

Kind Regards,

Caleb Brownley

Client Relations Team Leader

Camaf
Camaf's reply13 Sept 2018, 08:00
Official

Good day Paul

Thank you for allowing us the opportunity to investigate this matter and to provide you with accurate and comprehensive feedback. Firstly, we hope that you are recovering well from the unfortunate injury that you sustained. We are also distressed that you have not been able to see the partnership CAMAF provides in your journey to health and would like to remedy this.

Our investigations shows that in 2017, you were on the First Choice option which did not require a referral from a network general practitioner (GP). On your current option, Network Choice, a referral is required before consulting another service provider such as a physiothe****** or specialist. Belonging to a network based option, requires CAMAF members to make your network GP your first point of call. If necessary, your network GP will then refer you to the appropriate practitioner to treat your medical condition. CAMAF provides a day-to-day (D2D) benefit of R3040.00 to facilitate payment of these claims so there would have been no need for you to pay for a consultation at a network GP as you still have this benefit available.

The need to see a network GP first extends to a number of other practice disciplines (not just a Physiothe******) including but not limited to:

· Specialists (such as a Physician or Orthopaedic Surgeon, etc.).

· Supplementary Health Professionals (such as a Physiothe****** or Occupational The******)

· Radiology (X-rays & advanced scans such as a CT-Scan)

· Pathology (Blood tests)

The Network Choice option provides adequate support & benefits for members, provided the protocols for the option are adhered to. We would love to help you further and suggest a personal phone call to you to discuss and explain your benefit option in more detail. Our aim is to help you get the best possible benefits from it.

Please confirm a suitable date and time for us to contact you in this regard.

Warm regards,

Caleb Brownley

Client Relations Team Leader

Camaf
Camaf's reply13 Sept 2018, 08:00
Official

Good day Paul

Thank you for allowing us the opportunity to investigate this matter and to provide you with accurate and comprehensive feedback. Firstly, we hope that you are recovering well from the unfortunate injury that you sustained. We are also distressed that you have not been able to see the partnership CAMAF provides in your journey to health and would like to remedy this.

Our investigations shows that in 2017, you were on the First Choice option which did not require a referral from a network general practitioner (GP). On your current option, Network Choice, a referral is required before consulting another service provider such as a physiothe****** or specialist. Belonging to a network based option, requires CAMAF members to make your network GP your first point of call. If necessary, your network GP will then refer you to the appropriate practitioner to treat your medical condition. CAMAF provides a day-to-day (D2D) benefit of R3040.00 to facilitate payment of these claims so there would have been no need for you to pay for a consultation at a network GP as you still have this benefit available.

The need to see a network GP first extends to a number of other practice disciplines (not just a Physiothe******) including but not limited to:

· Specialists (such as a Physician or Orthopaedic Surgeon, etc.).

· Supplementary Health Professionals (such as a Physiothe****** or Occupational The******)

· Radiology (X-rays & advanced scans such as a CT-Scan)

· Pathology (Blood tests)

The Network Choice option provides adequate support & benefits for members, provided the protocols for the option are adhered to. We would love to help you further and suggest a personal phone call to you to discuss and explain your benefit option in more detail. Our aim is to help you get the best possible benefits from it.

Please confirm a suitable date and time for us to contact you in this regard.

Warm regards,

Caleb Brownley

Client Relations Team Leader

PM
Paul M's update13 Sept 2018, 09:23
Reviewer Update
Hi Caleb, Thank you for the feedback and well-wishes. I changed options because the increase in monthly premiums based on my salary changing from first to second year meant that I would be earning less if I remained on First Choice than I was in my first year of articles. I can appreciate the desire to make a Network GP the first point of call but only to the extent that the GP can actually add value. For instance, where your injury might require a specialist like an Orthopaedic Surgeon (an injury of this kind is dramatically more serious than a back mobility and body alignment issue), a GP's discretion is required to determine if the injuries are serious enough to require the aid of a specialist. However, where it is an injury that a physiothe******/chiropractor has previously, and successfully treated, to get a referral from a GP just to go to the physio you know can help you is a waste of both their time and mine. I would like to know what value a GP would add in the referral process to a physio other than providing a referral letter and, therefore, why this should be a requirement? I am available to discuss this anytime today or tomorrow between 8am and 5pm. Should you need my contact number, I will provide this in a private response. Kind regards, Paul
PM
Paul M's update13 Sept 2018, 09:23
Reviewer Update
Hi Caleb, Thank you for the feedback and well-wishes. I changed options because the increase in monthly premiums based on my salary changing from first to second year meant that I would be earning less if I remained on First Choice than I was in my first year of articles. I can appreciate the desire to make a Network GP the first point of call but only to the extent that the GP can actually add value. For instance, where your injury might require a specialist like an Orthopaedic Surgeon (an injury of this kind is dramatically more serious than a back mobility and body alignment issue), a GP's discretion is required to determine if the injuries are serious enough to require the aid of a specialist. However, where it is an injury that a physiothe******/chiropractor has previously, and successfully treated, to get a referral from a GP just to go to the physio you know can help you is a waste of both their time and mine. I would like to know what value a GP would add in the referral process to a physio other than providing a referral letter and, therefore, why this should be a requirement? I am available to discuss this anytime today or tomorrow between 8am and 5pm. Should you need my contact number, I will provide this in a private response. Kind regards, Paul
PM
Paul M's update13 Sept 2018, 09:34
Reviewer Update
Hi Caleb, Additional to my reply above, I wonder if the purpose of forcing clients to make use of a GP for referral purposes (which you say can be claimed against the Day-to-Day benefit) is to exhaust the Day-to-Day benefit more rapidly? This way, each time a patient requires physiotherapy, they first consume +/- R600 of their benefit each time a new injury arises? Can you confirm if this is the intention? If this is the case, it surely doesn't give the impression that CAMAF is helping members work towards a healthy lifestyle. If I need physiotherapy and CAMAF is happy to pay a useless referral fee, surely that R600 for the referral fee would better serve a member if they could put it all towards the health practitioner that would fix their injury etc. if CAMAF is paying the money anyway? None of this requirement makes sense. Thanks, Paul
PM
Paul M's update18 Sept 2018, 08:59
Reviewer Update
Hi Caleb I can't say I'm surprised but I'm still waiting for a call from CAMAF. As CAMAF is not showing a desire to address this, I have submitted my complaint to the Council for Medical Schemes.
Camaf
Camaf's reply18 Sept 2018, 09:32
Official

Good day Paul

My apologies for the delay in responding to you.

Your enquiry has been referred to our Clinical Team for review. I will send you the feedback via email within the next 30 minutes.

Warm regards,

Caleb Brownley

Client Relations Team Leader