SHOCKING SERVICE & COMMUNICATION - FEDHEALTH & CENTAURI
HEREWITH MAILS - COPIED AND PASTE - AS EXPLANATION.
I'M BACK AT SQUARE 1 - WITHOUT ANY RESOLVEMENT OF ACCOUNTS AS PROMISED.
JUST CONFIRMED: FEDHEALTH CALL CENTRE AGAIN REJECTED PAYMENT OF ACCOUNTS AS CENTAURI (AS DESIGNATED SERVICE PROVIDER) DID NOT SUBMIT ACCOUNTS WITH CORRECT PRACTICE NUMBERS. NOBODY CARES! IF I DID NOT PHONE FDEHEALTH CALL CENTRE TO CHECK-UP, NOBODY WOULD HAVE DONE ANYTHING TO RECTIFY THE PROBLEM!
I'M APPAULED AND MORE FRUSTRATED THAN EVER!
IT'S BEEN 2 MONTHS THAT I'M TRYING TO SORT OUT THIS MESS!
CAN SOMEBODY AT FEDHEALTH AND CENTAURI JUST ACT AS IF THIS WAS YOUR OWN 72-YEAR OLD DAD FOR ONCE AND HELP!!!!
From: Lize (van Wyk) Duvenhage ********** Sent: 21 August 2017 04:27 PM To: 'Kevin Hogg' Subject: RE: Mr van Wyk - Fedhealth Prosthetic Benefits
Just an update: it’s been a week since you hand-delivered the accounts - no news yet.
Regards,
Lize.
From: Kevin Hogg ********** Sent: 15 August 2017 08:49 AM To: Lize (van Wyk) Duvenhage Subject: Re: Mr van Wyk - Fedhealth Prosthetic Benefits
Hi Lize,
Just an update.
We hand delivered the two accounts to Fedhealth yesterday.
The accounts will be processed and hopefully payment will be on the next payment run.
You should receive feedback before me as you are the member.
Please let me know what happens, thanks
Regards Kevin Hogg Chief Executive Officer Centauri Medical Services (Pty)Ltd Fax: ********** Mobile: ********** E-mail: ********** Skype: kevin_hogg
On 8 August 2017 at 21:48, Lize (van Wyk) Duvenhage ********** wrote: Kevin, Thanx for your reply and commitment to assist in this matter. Please keep me updated. Regards, Lize. From: Kevin Hogg ********** Sent: 08 August 2017 07:52 PM To: Lize (van Wyk) Duvenhage Subject: Re: Mr van Wyk - Fedhealth Prosthetic Benefits Hi Lize, Sorry for the late reply. See comments below
Regards Kevin Hogg Chief Executive Officer Centauri Medical Services (Pty)Ltd Fax: ********** Mobile: ********** E-mail: ********** Skype: kevin_hogg On 8 August 2017 at 15:49, Lize (van Wyk) Duvenhage ********** wrote: Kevin, Thank you for your reply and explanations. I’m absolutely dumb-founded with what I read here. Really... No jokes. Sorry my abrupt and informal way of saying it as it is. I’ve got no words. As I mentioned: up to yesterday I’ve never heard of the relationship between Centauri and Fedhealth. Not once in the past 4 years that I dealt with my dad’s medical expenses after his amputation 4 years ago. Never. Not from any call centre agent. Not in any emails between me and Fedhealth. I think if Fedhealth would give you insight into my dad’s portfolio you will also see that this has never happened. As I say: absolutely dumb-founded... But you know, that’s beside the point. What I need, is to sort out the payment of the accounts at hand and position us for the way forward. That’s the focus. Icexpress did send a quote through to Fedhealth, after wich Isabel Scheepers rep**** and ask for an invoice so that it can be paid – which I send on 10 July. I’m going to send you that correspondence in a separate email. I’m attaching the accounts as well as you asked. Please tell me: If we opt for the scenario where a service provider is paid annually, what is the benefit that is paid to such a service provider per year? Is it the R10,500 as on Fedhealth’s website? Sorry I haven't checked the plan that you Dad is on but that amount seems correct. If it is, why can’t we just organize for the annual payment to be paid to Icexpress, then the 2 accounts will be covered. The total outstanding is R5131.37. The annual amount can't be paid out as a lump some to one practice as it covers all external devices. As accounts are submitted these amounts are paid out of this benefit until the limit is reached. Please advise. Leave these accounts will me and I will get them hand delivered and processed. Sorry for all your trouble, but hopefully we can get this all resolved. Thanx Lize. From: Kevin Hogg ********** Sent: 08 August 2017 10:52 AM To: Lize (van Wyk) Duvenhage Subject: Re: Mr van Wyk - Fedhealth Prosthetic Benefits Morning Lize, Thank you for your email. Please see my comments below, which I hope to answer your questions.
Regards Kevin Hogg Chief Executive Officer Centauri Medical Services (Pty)Ltd Fax: ********** Mobile: ********** E-mail: ********** Skype: kevin_hogg On 7 August 2017 at 21:45, Lize (van Wyk) Duvenhage ********** wrote: Goodday Kevin, Thank you for your email. Apologies that I’m only replying today – I was on leave in the Kruger until yesterday. I’m handling all my dad’s medical aid claims and admin since about 10 years ago. I would like to request that my dad NOT be called regarding admin and decisions to be made regarding medical services rendered, claims etc as he is no longer capable of doing so. Thank you, noted. I’ve been trying for weeks to get an answer from Fedhealth on payments to Icexpress regarding a new leg that he needed after a revision of his stump in March, and I’m sure you can understand my anger and frustration when I received Isabel Scheepers’ email – which I only read for the first time about an hour ago... I understand your frustration, but let me try to resolve the problem. I am totally blown-away by all the details she shared in the email, as well as what you are trying to explain to me. Does this all mean that you are administrating all prosthetic services on behalf of Fedhealth? I’m a bit confused... I also mailed her. Herewith my questions I asked: Centauri has for more than 10 year administrated all prosthetic services to Fedhealth members. Fedhealth call centre agents are trained to handle members and practices queries regarding prosthetic benefits. Call centre agents will assist as best as they can but in most instances members and practices are referred to us for further clarification of the prosthetic benefit options available to members. Call centre agents are also authorised to give out my personal cell number. Email queries are also forward to my personal email account. On receipt of either a call or email the following steps are taken: 1. We call the member and explain the 3 options available. 2. If requested by the member we will also call the practice to explain these option. In the case of Icexpress, they already provide services to Fedhealth members, through our 5 year process. I;m therefore not sure why they did not inquire to add the Dad onto the 5 year contract. I'm also unsure why they would undertake work without prior approval from Fedhealth. Had they submitted a quote to Fedhealth on behalf of your Dad's prosthesis this quote would have ended on my desk to follow through as per above. 3. After the member has received all the information on the benefit options they decide which option to choose. 1. In which official communication to Mr van Wyk was it confirmed that only Centauri Orthopaedic Centre must be used as service provider? Mr van Wyk is a patient at Mr JJ Snyders (Icexpress) for the last 4 years. Previous accounts was settled. Never before was it communicated to Mr van Wyk that he cannot use Mr Snyder’s practise. It is the very first time ever I hear the name of Centauri! Centauri is the designated service provider for Fedhealth. I can't answer why this has not been communicated via Fedhealth. Icexpress however is aware of the process as they have other Fedhealth patients on the five year contract, which is administered through us. The only time that the member or practice does not have to go through Centauri is if the member elects to use the amount as per their benefit plan. So after we have explained the options and the members decides to use the annual limit option, with the understanding that any cost over and above that amount is for their account we inform Fedhealth accordingly. The practice can then submit their accounts directly to Fedhealth for payment. 2. Centauri Orthopaedic Centre is situated in Bruma, Johannesburg. Mr van Wyk stays in Pretoria. How is it possible that Fedhealth can enforce and expect a patient to travel from Pretoria to Johannesburg for rehabilitation of a prosthesis?!? Who will pay for the travel expenses?!? While Centauri has its main office in Bruma services are provided to Fedhealth members around the country. We do have a practice in Pretoria so it won't be necessary to come to Bruma. In most cases we do understand members limitations regarding travel and in these case we travel to the member. 3. I see that a patient is only viable for a new prosthesis every 5 years? What does a patient do if he had – like the case of my dad – a revision (shortening) of the stump – and he needs to get a whole new prosthesis? He can’t use the old one. The whole stump is a new shape and length. Under the 5 year contract the member is entitled to a new prosthesis every 5 year including all refits and consumables over this period. In the case of your Dad's revision this fall under refits, which is included. Furthermore: Where does it leave us with the 2 accounts that needs to be paid for service already rendered by Johan and his team at Icexpress in July? Attached. Unfortunately I can't open the attachments, if you can resend them them in a different format I'll happily look into this for you. Do you know if Icexpress submitted a quote for these services to Fedhealth prior to doing the work? You are welcome to answer me via email or phone me on ********** 273. Regards, Lize Duvenhage Tel: ********** 060 Cel: ********** 273 ********** From: Kevin Hogg ********** Sent: 02 August 2017 04:01 PM To: ********** Isabel Scheepers Subject: Mr van Wyk - Fedhealth Prosthetic Benefits Dear Mr. van Wyk, Charl from my office called you earlier today to explain the prosthetic benefit options available to you as a Fedhealth member. I thought I would follow this up with an email to further explain our role and the 3 options available. Our Role For more than 10 years we have provided a support role to the Fedhealth call centre with regard to explaining the 3 prosthetic benefit options available to members. Our main function is to ensure that members are fully aware of all their options when claiming prosthetic devices and to assist them in choosing the best option for them. All prosthetic queries received from members by Fedhealth are forwarded to our office. Fedhealth members have 3 options. Option 1 • You may choose freely your service provider and claim against available annual benefit. • Any cost over and above the limit are for the members personal account • There is no ex gratia consideration for these additional costs. Option 2 • You may freely choose your service provider • The member elects to go onto the 5 year prosthetic program • The service provider has to agree with the reimbur*****t model the salient features are: o The service provider is paid a fixed amount over 5 years increasing every year in January o The service provider will supply and maintain the prosthesis for 5 years including refits and consumable items o The member receives a mid range prosthesis and on this basis there is no co-payment. o If the member elects at their own choice more advanced components, then these additional costs will be for their account. Option 3 • In the event that the members preferred provider is unwilling to enter into a 5 year contract but the members wants the benefits of then 5 year contract, then we refer the member to an alternative provider. Please let me know if I can be of any further assistance. Regards Kevin Hogg Chief Executive Officer Centauri Medical Services (Pty)Ltd Fax: ********** Mobile: ********** E-mail: ********** Skype: kevin_hogg Virus-free. www.avast.com
From: Lize (van Wyk) Duvenhage ********** Sent: 07 August 2017 09:04 PM To: ********** Subject: RE: ********** 8902 - ********** 8902 [MI ********** 84] Importance: High
Isabel,
Thank you for your detailed email.
Can you please answer the following questions I have:
1. In which official communication to Mr van Wyk was it confirmed that only Centauri Orthopaedic Centre must be used as service provider? Mr van Wyk is a patient at Mr JJ Snyders (Icexpress) for the last 4 years. Previous accounts was settled. Never before was it communicated to Mr van Wyk that he cannot use Mr Snyder’s practise.
2. Centauri Orthopaedic Centre is situated in Bruma, Johannesburg. Mr van Wyk stays in Pretoria. How is it possible that Fedhealth can enforce and expect a patient to travel from Pretoria to Johannesburg for rehabilitation of a prosthesis?!? Who will pay for the travel expenses?!?
3. I see that a patient is only viable for a new prosthesis every 5 years? What does a patient do if he had – like the case of my dad – a revision (shortening) of the stump – and he needs to get a whole new prosthesis? He can’t use the old one. The whole stump is a new shape and length.
Your urgent response to my questions will be highly appreciated!
Lize Duvenhage Mr van Wyk’s daughter.
From: ********** ********** Sent: 02 August 2017 01:58 PM To: ********** Subject: ********** 8902 - ********** 8902 [MI ********** 84]
Dear Mr van Wyk
Your reference number: 260717Q8S78Z
Thank you for your e-mail.
The claim for Mr JJ Snyders, practice number ********** , treatment date 10/07/2017 for the amount of R3667.10 was rejected. This is due to the DSP (designated services provider) for the external prosthesis was not used.
Please note that Centauri Orthopaedic Centre is the Scheme¿s DSP for prosthesis.
The contact details for Centauri Centre is as follows:
22A Ernest Oppenheimer Road Bruma Telephone number: ********** E-mail address: **********
Benefit includes the following:
Manufacture, supply and management of the prosthesis Each authorised amputee member of Fedhealth will be entitled to:
New prosthesis every 5 years Refits and adjustments, as and when required Consumable items such as stump socks and creams, as and when required; And Monthly consultations, or as required by the patient
Amounts payable:
Fedhealth agrees to pay a monthly in arrears according to a table set out. The monthly amounts will be adjusted each year in January by the average of the previous 12 months CPI (Health) index as quoted by Statistics SA.
Claims will pay from risk, over and above the external prosthesis benefit limit. Should the membership be terminated, a final statement will be submitted to the Scheme for the final settlement of the outstanding charges. Final statement must be forwarded to Fedhealth SCA, to present to the Fund Manager, to approve the final settlement.
Centauri¿s Orthotist:
Will set up a meeting with you. They will supply you with his/her prosthesis as per the Fedhealth agreement. They will do all the alterations at no extra charges / cost to the member. Should you request a more advanced prostheses, they can discuss it with Centaur¿s Orthotist and arrange to pay the difference between the Fedhealth Rate and the advance prosthesis to the supplier themselves.
Ownership of the prosthesis:
Ownership of the prosthesis remains with Centauri Orthopaedic Centre at all times, unless settled in full by Fedhealth. Once Centauri has received the final settlement, the prosthesis will belong to the patient.
Components:
Ensuring the highest level of service and outcomes for the members, Centauri Orthopaedic Centre predominately uses components imported from Otto Bock (Germany) a world leader in prosthetic components. In the event of circumstance outside control, Centauri may elect to use other components of a similar quality standard.
I have requested for an consultant from Centauri to contact you for further assistance.
Kindly update your personal details on a regular basis, to ensure that you receive the latest updates from Fedhealth.
If you need any more information, please contact us on email to ********** or fax to ********** . Alternatively you can contact our Call Centre on 0 ********** 53/4.
Here¿s to our family taking care of yours.
Kind Regards
Isabel Scheepers