BAD CUSTOMER SERVICE

Fedhealth

If you are ever considering medical aid, think twice about Fedhealth.

Despite the protections afforded to members under the Medical Schemes Act (Act 131 of 1998), Fedhealth appears to actively seek loopholes to avoid authorising claims, even when these claims relate to Prescribed Minimum Benefits (PMBs). PMBs are a legal entitlement and must be covered in full, subject to the applicable diagnosis, treatment, and care (DTP) requirements — regardless of how long a member has belonged to the scheme.

My wife was diagnosed after joining Fedhealth with endometriosis, and it was confirmed that her uterus is growing towards her back. She requires a medically necessary hysterectomy. The diagnosis, referrals, and detailed motivation were submitted by both the GP and the treating specialist.

In terms of the Medical Schemes Act and Council for Medical Schemes (CMS) regulations, medical schemes are legally obligated to fund PMB conditions in full and may not refuse authorisation through administrative delays, technicalities, or selective interpretation of pre-existing condition rules.

Fedhealth has been very quick to deduct monthly contributions from our bank account, yet unwilling to comply with its statutory obligations when authorisation for essential treatment is required.

Members should not have to fight their medical scheme to access care that is legally guaranteed. I strongly advise prospective members to reconsider joining Fedhealth and rather choose a scheme that complies with the law and prioritises patient care.