TD
Thanushka D

1 reviews | Active since Jul 2021

06 Jul 2021, 19:57

Medical AID Short pays authorized claim

I have been on the medical aid for over 10 years via my husbands company In March, I underwent a procedure, at the Waterfall Hospital, on my spine to remove the C3/C4 disc in my neck which immobilized for approximately 8 weeks. In that time I had to visit my specialist to track my progress for which he requested an MRI/ CT Scan via the hospitals radiology department as I needed further treatment. The process at the radiology is to call the medical aid and confirm an authorization which implies full payment. Helen at X-Ray reception confirmed the approval. There will be no co-payment on the side of the patient ( that is myself) and the scan may proceed. Subsequently, a few months later I received an invoice that the medical aid short paid the Service Provider ( the radiology department) and I was to pay in, a substantial amount of over R2000. I queried with the medical aid and after much back and forth, and much discussion, supplying the medical aid with the authorization number given to the radiology department including the case manager who confirmed the payment. The medical aid advised me they listened to the call, it was taken by an agent of theirs and the agent did confirm that there will be no payment. They agreed that the short payment will be made as it was an error on their side and they need to honour their commitment. Thuli at medical aid was adamant that she escalated and that payment in full was to be made. This did not happen, when I queried again ,the feedback was that what we queried another previous payment made to the radiology department. Their story completely changed. When I escalated, and asked for feedback, I have received none (several times). At present I am now in a situation where the Waterfall Radiology Department has sent me a letter of demand for the short payment from the medical aid, they will be handing me over for collection. Considering I have been through a painful ordeal in the aforementioned operation, the recovery from which has been slow and I have yet to attain complete mobility, this has added to this stress of the recovery. Medical aid query ***

Very disappointed and unhappy client

0
Replies (2)
Discovery Health
Discovery Health's reply07 Jul 2021, 07:20
Official
Dear Th****hka D

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 

Regards 
Discovery Health Servicing Team

Discovery Health
Discovery Health's reply09 Jul 2021, 19:07
Official
Dear Th****hka D

Please check your emails for feedback from us.

Regards 
Discovery Health Servicing Team