No assistance received, not even from the CEO!!!

From: Najma Sallie Sent: 30 November 2017 2:56 PM To: ********** ********** Cc: ********** ********** ********** ********** Subject: Complaint against Remedi Health -MailRef# ********** 421#-

Good day,

@Council for Medical Schemes: Reference number 67315 refers.

@Remedi:

Thank you for the feedback.

Please note, I have submitted proof that the details were captured correctly by myself – please provide your proof that the information supp**** was incorrect?

Secondly, I have requested the call between your agent and the Dr’s rooms time and time again yet to this date, Remedi avoids and blatantly ignores this request.

Can you please inform me as to why I keep getting these generic replies from your office? No one is answering my questions. Yes, I should be happy that the payment to Doctor was finally made however, you tell me, based on what did you process a claim one year later? What are your findings as to me it seems like you are protecting your agent here.

I await your response.

Regards,

Najma Sallie

From: Najma ********** Sent: 30 November 2017 2:47 PM To: Najma Sallie ********** Subject: Fw: Complaint against Remedi Health -MailRef# ********** 421#-

-------- Original Message -------- Subject: Complaint against Remedi Health -MailRef# ********** 421#- From: ********** To: ********** CC: ********** Dear Miss Sallie Thank you for bringing your concerns to our attention. We paid your late claim as an exception The claim for Dr PG Beale dated September 2016 was submitted electronically to the Scheme on 18 October 2016. The claim was submitted with the incorrect membership number and was therefore not captured on your membership. The Scheme only received the amended claim with the correct membership on 15 November 2017. In terms of legislation, claims remain valid for a period of 4 months from the date of service. As this was received outside of this period it is considered a late claim which is in line with the Medical Schemes Act. We reviewed and approved your late claim to pay as an exception. We processed the claim as follows: Treatment date Amount claimed Amount paid Paid to Reason code Date of payment 21.09.2016 R 5700.30 R 2889.50 Provider * Reason code 391: We paid the amount on this line according to the agreed payment arrangement. 20.11.2017 We paid the claim according to the payment agreement we have with the provider in respect of which the provider may not charge more than the agreed rate and you are thus not responsible for the balance of the claim. All claims remain the member’s responsibility which means that it is your responsibility to make sure that all your accounts are submitted to the Scheme within the valid claiming period. We can find no evidence of this account being submitted by yourself within this period. As the Scheme covers medical expenses only, the interest and legal fees charged on this account remains your responsibility. If you have any more questions, please send an email to ********** or call Client Services on ***. Alternatively, you can access the website at www.yourremedi.co.za Kind regards Fiona Mitchell On behalf of Remedi -------------------------------------------------------------------------------------------------------------------------- From: Najma Sallie ********** Sent: Wednesday 29 November 2017 03:49 PM To: Adrian Gore ********** Cc: Marisa Valentine ********** Subject: Complaint against Remedi Health Good day Mr. Gore, I hope this email finds you well. It is with a heavy heart that I write to you. My son was born at 26 weeks on the 17th of June 2016. He spent 14 weeks in the NICU of Garden City Clinic and that is why I #fightlikeapreemie. Three days after discharge my son was re-admitted and had to undergo an emergency procedure for a bilateral inguinal hernia repair. The procedure was authorized by the scheme. The surgeon, Professor Beale submitted the claim timeously however said claim was rejected 8 times by medical aid as they claim the membership number was 1. Captured incorrectly 2. Belongs to someone else. I have been a member of this scheme since 2012 and been on Keycare for +-8 years prior so there is no way that I would capture any information, as important as this, incorrectly. Please see below: 1. The hospital form I personally completed: 2. The membership certificate: After logging the complaint with your service desk, the Doctor was paid however the external debt collection agency now holds me liable for the legal fees incurred. Mr. Gore, I believe I am not liable for said fees as I did what was required of me. I thank you for settling more than R1million fees for my little boy, something I will forever be grateful for. I have requested, more than once, the recording between the Dr’s rooms and the medical aid as I believe this is where the confusion stems from. I have not had any luck with your consultant, Marisa Valentine which has now led me to logging a formal complaint against the scheme with the Council for Medical Schemes. The attorneys have now offered me a settlement of R870 in order for the file to be closed, my payment profile be updated and the adverse listing against my name to be removed. A mere R870 is not even small change to your multimillion rand company but to a single parent of 4, it hits my pocket very hard. I will not go to this extremes if I was in the wrong however unless proven that I am in the wrong, I will pay the fees. I await your response. Regards, Najma Sallie From: Najma Sallie Sent: 29 November 2017 3:13 PM To: ********** ********** Cc: ********** ********** ********** 'Marisa Valentine' ********** Subject: Complaint against Remedi Health Good day, Please see attached. Regards, Najma Sallie Disclaimer This message and any attachments are confidential and intended solely for the addressee. If you have received this message in error, please notify Remedi Medical Aid Scheme immediately, telephone number ***. Any unauthorised use; alteration or dissemination of the contents of this email is strictly prohibited. In no event will Remedi Medical Aid Scheme or the sender be liable in any manner whatsoever to any person for any loss or any direct, indirect, special or consequential damages arising from use of this email or any linked website, including, without limitation, from any lost profits, business interruption, loss of programmes or other data that may be stored on any information handling system or otherwise from any assurance that this email is virus free even if Remedi Medical Aid Scheme is expressly advised of the possibility of such damages. Remedi Medical Aid Scheme, registration number 1430.