dV
deon V

1 reviews | Active since Jul 2012

16 Apr 2019, 15:01

claim processed wrong and I must wait

Good day I visited a dentist which requested I must pay him and claim from my medical aid. So I did processed the claim with the documentation and proof Fedhealth requested from me to refund me and not the dentist.

However for some reason someone in the claims department made a stuff-up and they paid the money to the Dentist and not to me and I clearly stipulated it must be paid to myself. during the claim and phoned also a few times to make sure if they are on the ball regarding my claim because it was taking to long according to me and when eventually I received some automatic email feedback I could see the ball is starting to roll. Then eventually I found out it takes 7 to 10 working days extra to process and pay the claim.

Eventually I could see that the money is approved and is going to be paid to the dentist and not me. That is when a wonderful lady on your chatbot helped me to try and stop the payment. Unfortunately it looks like the payment was stopped. However I received an automatic mail again where it state that the money was paid to the practitioner. So I queried it again and I was told that it was in fact stopped and the claim is at the assessors and it will take another 7 to 10 working days to pay out to me.

So my biggest complaint is that really I need to wait another 7 to 10 working days for your stuff-up, just because claims department can't read instructions when a client submitted a claim? Poor and slow service and in the meantime I need to walk with an empty pocket and some times you ask the question why do you have a medical aid if you need to pay your self and claim later at a medical aid that is *********** in processing claims. Cant this claim be fast tracked and be processed quicker due to the stuff-up you guys made?

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Replies (4)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply16 Apr 2019, 15:10
Official
Thank you so much for your review we will be in touch shortly.
Kind Regards
The Fedhealth Online Team
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply18 Apr 2019, 08:47
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards The Fedhealth Online Team
dV
deon V's update18 Apr 2019, 10:27
Reviewer Update
Yes an agent who handle the hellopeter complaints did phone me. I requested that a claims manager phone me and eventually a supervisor phone me and explained the same thing the agent did on Wednesday night. I eventually did not accept the excuse and asked if a manager can phone me and I was told Friday is a public holiday and no managers will be available. So I assume managers get an extra public holiday on a Thursday just because they are managers and work hard and think out **** processes that prevent the clients to get their money. I requested then that one of the managers pay me the money out of his own account and he can claim for the money and then if he is lucky he will get the money back in his account in 7 to 10 working days because mine is taking now a month. The moral of the story is that not once did someone phone me and say sorry for the mistake after I notified them they made a mistake and all they did was starting the claim process over. Where is the integrity and accountability to admit you made a mistake and fix it ASAP. The companies I worked for if we owe the client money and stuffed up we immediately created a new EFT and made sure the money is in his account in the next 12 hours or immediately via speed payment. So Fedhealth managers enjoy your extra long weekend because I wont. Hope I will hear from one of the managers or the head of claims because I have allot to say to you. The CEO is also welcome to phone me. That will be an interesting conversation.
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply23 Apr 2019, 12:47
Official
A consultant has been in contact with you and detailed feedback has been provided. 
Kind Regards The Fedhealth Online Team