Claim

I HAVE BEEN PHONED BY A CONSULTANT AND TOLD I MUST WAIT FOR THE COUNCIL BUT WHAT DOES THIS MESSAGE MEAN THEN ?

Thank you for reviewing my claim

The following claim query has been received and reviewed.

Membership number: ********** 1445 00
Name and Surname: Mr Frans D Roodt
Provider: ********** Dr Manoussakis D

The following claim has been approved and will be sent to be reversed and reprocessed accordingly.

ICD 10: G40.9
Date of service: 23/03/2017
Tariff codes: 0192, 2711, 2712

Kind regards
The ambulatory PMB team

Dear Mr. Roodt,

Please don't tell me i must contact the council again your answer is due today

Kindly note that the scheme’s response is only due on Friday 28 May 2017. We will forward you a copy of the response once it becomes available.

Regards,

From: Frans Roodt **********
Sent: 26 April 2017 02:54 PM
To: Ronelle Begemann ********** >
Subject: Fedhealth

Good day a while ago i submitted a complaint about Fedhealth but everytime i contact them i get the answer to directly contact the CMS as they do not handle the complaint any longer. A consultant phoned me recently but didn't know anything about the below e mail i received from them. I asked when will the refund be made processed according to the below message. Your help will be appreciated.

Thank You

Good day

The following claim query has been received and reviewed.

Membership number: ********** 1445 00
Name and Surname: Mr Frans D Roodt
Provider: ********** Dr Manoussakis D

The following claim has been approved and will be sent to be reversed and reprocessed accordingly.

ICD 10: G40.9
Date of service: 23/03/2017
Tariff codes: 0192, 2711, 2712

Kind regards
The ambulatory PMB team

The answer

Dear Mr. Roodt,

Kindly note that the scheme’s response is only due on Friday 28 May 2017. We will forward you a copy of the response once it becomes available.

Regards,

I received feedback from the council CMS which told me Keyhealth must give feedback on the 28th the 28th has come and gone NO ANSWER RECEIVED I ALSI RECEIVED AN EMAIL FROM FEDHEALTH THAT TOLD ME THE CLAIM HAS BEEN REVIEWED AND WILL BE PROCESSED ACCORDINGLY BUT STILL I GET NO ANSWER ON WHEN THE AMOUNT WILL BE PAID ACCORDING TO COMMUNICATION RECEIVED THAT ITS BEEN REVIEWED AND PROCESSED ACCORDINGLY THIS TIME I WONT BE TOLD TO LIASE WITH THE COUNCIL AS YOUR ANSWER IS DUE

Im referring to this

The following claim query has been received and reviewed.

Membership number: ********** 1445 00
Name and Surname: Mr Frans D Roodt
Provider: ********** Dr Manoussakis D

The following claim has been approved and will be sent to be reversed and reprocessed accordingly.

ICD 10: G40.9
Date of service: 23/03/2017
Tariff codes: 0192, 2711, 2712

Kind regards
The ambulatory PMB team

The council advised me I am to receive an answer from Keyhealth by the 28th which did not happen however Keyhealth is persisting i must wait for the council and thus avoiding giving an answer. I already received an answer from the council that Keyhealth is supposed to give me an answer by the 28th which did not happen im referring again to the email i received from Fedhealth above Claim Reviewed unless this didn't come from a Fedhealth representitive please confirm i can't believe i can't get an answer on an email Fedhealth sent me!

Thank you i received a reply from the council but i still need an answer on when which date and What Amount will be refunded as i need more clarity on that

Thank You

Good day could you please confirm the payment run dates via online chat i was informed by Claire every Tuesday and Thursday as i already converted this complaint which i think is fair but i don't want to log another

Good day please note that the amount of R 611 is incorrect according to Mrs Begemann of CMS.

Dear Mr. Roodt,

Kindly note in response to your query below, the scheme responded as follows:

· On the account the Scheme received on 24 March 2017, from Dr Manoussakis (a non Fedhealth specialist partner) amounting to R1, 700 for services rendered on 23 March 2017, this account was rejected as the member had no savings available. The service provider charged for the following procedure codes:

Ø 0192 - New and established patient: Consultation/visit

Ø 2711- Electro-encephalography

Ø 2712- Electro-encephalography

· Upon receipt of the CMS complaint the Scheme found that he above procedure codes forms part of the member’s treatment plan. Please refer to the attachment for the member’s detailed treatment plan.

· The Scheme has reversed and reprocessed the above account. The Scheme will pay an amount of R1,019.80 to the member by 18 May 2017.

· The short payment of 680.20 was due to the account being paid up to the Scheme rate.

Trust that this clarifies your query below.

Kind regards,