Inconsistency with Co-Payments !!!
Please advise on the following complaint regarding Netcare sunward park casualty.
I am member of GEMS medical aid( Emerald option). I would like to enquire on why there is inconsistency with the way in which billing is done .
My daughter was sick on the 5th of July and was seen by the casualty doctors and no co-payment was required. I only paid the difference after the medical aid only paid a certain portion which is fine and understandable.
On the 18th of October my husband twisted his ankle and had to be taken to casuality. Upon his arrival he was informed that he has to pay a co- payment of R410 that he had to paid and he did because he needed to be assistance.
I called Netcare billing department spoke to Shadè and she said it is like that and that all members on specific medical aid require a co- payment and it doesn’t matter where you go as long as its ER consulting at casualties you pay a co- payment. Only if its an emergency or you’re dropped off by an ambulance. You won’t have to pay the Co-payment.
She even said while you waiting to be seen by the Dr They put the claim through and co-payment amount will be reflected on their side, which is not true. The amount they charge you is standard.
What confused me is that the causality billed me the full R1080 which included the consultation. So does this mean that everytime I visit the hospital I should have R410 and if not they won’t treat me. I already pay a lot for the medical aid and sunward is listed as a network under my hospital plan. This doesn’t make sense. There is no communication eg a letter pasted on the wall stating that a Co-payment is required.
The worst part of it is the co- payment that is requested is a more than what the medical aid will say you should pay after they have paid which doesn’t make sense. Please advise on the following.
If it means I look for another hospital to take my family so be it. I will not be subjected to pay a co-payment that is thumb sucked and standard. There is already T and C’s that we sign that talks about co-payments.so why are we signing that if you will still pay a co-payment?
Please send me the communication that shows that GEMS is one of the medical aid that has a co-payment of X amount. If this is true. And advise how to desl with this, if it happens that one day I don’t have the R410 what will happen.
