AM
Arthurnette M

1 reviews | Active since Mar 2011

13 Dec 2018, 11:19

Claims not paid

I am pregnant and visited a GP who referred me to a Gynaecologist. I then called the Fedhealth for authorisation which was granted. Bear in mind that in the Scheme Brochure they confirmed that I have 4 visits per year to the midwife/gynae and that's not part of the day to day benefit. Now my Gynae prefer that you pay cash for your first visit then claim from Medical aid, I did so and claimed. The claim has not yet been refunded and I visited the gynae again and he submitted the claim to Fedhealth which also wasn't paid.

I called Fedhealth to follow up on why these claims were not paid and I was told that the claims were deducted from my day to day benefit which has now been depleted, so the agent said he will resubmit it for reprocessing because it must deducted from the Maternity benefit not on day to day as that's what caused the claim not to be paid and I must call after 5 days if I have not heard anything. So I called after 5 days and I was told that the other agent was not supposed to resubmit the claims as its not going to be paid because I don't have a Maternity benefit on the option that im on. Then I asked the agent why on the brochure does it says I have 4 visits to the midwife/gynae if I don't have a maternity benefit and why did Fedhealth send me a Maternity/ Baby bag if I don't have that benefit and why am I registered on Fedhealth's baby programme if I don't have the benefit? that agent didn't have answers to any of my question and when I call Fedhealth and enquire more about im being placed on hold and no one ever comes back to me.

The gynae refereed me to another specialist which was also not paid but the funny part is that the medication that doctor prescribed was paid even though I don't have funds, now the questions is where all of a sudden they got the money.

Fedhealth was 1 of the best Medical aids and now its the worst. Their contributions are getting more expensive but their service is getting poorer. I am pregnant and I am under a lot on stress because of this. And I wonder if my hospital bill will be paid as they make promises they cant keep.

please assist

0
Replies (2)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply13 Dec 2018, 16:17
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 reply21 Dec 2018, 11:13
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards 
The Fedhealth Family