ML
Michelle L

1 reviews | Active since Mar 2014

20 May 2015, 12:04

Claims department wrongfully declining PMB claims

I thought that my nightmare with Fedhealth was over from last year but their incompetence continues. I have systemic lupus erythematosus, a very serious autoimmune illness which entitles me to certain PMB benefits. I have had to submit a number of claims that clearly state the ICD10 code M32.1 on it only to have them reject it saying that I have used up my benefits and that I must resubmit with the ICD10 code M32.1. This has happened three times now. I am at my wits end. Every time I phone, the consultant can clearly see the correct ICD10 code and they say they will escalate it and resubmit it. After several weeks I get an email rejecting it for the same reasons. I phone again.....and the cycle continues. It seems that the claims department has no idea what they are doing or they just don't bother to read the claims properly. It seems that are quick to reject claims rather than look to help the client. The stress this is causing is detrimental to my health. I pay Fedhealth a lot of money and expect them to hold up their end of the deal but it seems they are incapable of doing so. This is unacceptable.

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply20 May 2015, 12:09
Official
Hello Shells34,

Thank you for letting us know that you are not entirely happy with the level of service you have received. We are currently looking into your query and a consultant will contact you once we have a result.

Kind Regards
The Fedhealth Online Team