Dishonest / Terrible Service / Non responsive

Dishonest / Terrible Service / Non responsive on claim email / Call center staff even worse and not educate in their own product and features / Also seems like no client record as if you cant provide the date you emailed an claim they cant assist. How can a company this size operate like this ??

Example 1 : Claims switched around, not to be paid from major medical benefit

Wife went for medicine to Dischem, letting me know the medical aid only paid a portion and she had to pay in as the savings are depleted. Not a problem at all here Had dentist appointment same day, basic checkup, 1st one in years. Never knew we do get 2 checkups and cleanings per year... Now when the saving are depleted you other benefits are active and paid from risk... Meaning the checkup, cleaning etc must be covered from risk...

Fedhealth conveniently switched these claims around... Not paying Dischem, after payment was confirmed leaving our account in the red when we showed up again. Paid the dentist the odd R300 they had to pay to Dischem. This leaving us with the quite huge dentist balance as well as the Dischem account. - Call center hard asses and reluctant to help, apparently cant be undone - Was escalated to floor manager stating we must prove it... What?? so you are guilty until proven innocent??? **** way to be treated as they could have sorted all this out in house and requested the invoices from the providers themselves. - After proof was gatherer... (payment receipts with actual time of transactions on) we were told to follow the email route. And we all know this route turned to **** as there is no response... - email was sent 21 June, email was re-forwarded stating their turnaround time is **** on 9 July. When you phone they say you must be patient because the turnaround time is 7 days. Seems like they can also not count in this case. After what we went through on Example 2 i do doubt that this was an accident or error but rather the way things are done to pay as little as possible.

Example 2 : Dishonestly, or if this statement not acceptable, Uneducated staff

On various occasions, chances has been taken to not pay bills. Attending doctors not paid as not listed, specialists not paid as not associated. All these items are covered by the in hospital benefit when in an accident. But the scheme takes the opportunity not to pay them, the member has to phone and phone and phone, advising and reminding that this is all in hospital treatments and then only after allot of effort claims are sent for re-processing. Now what is this? I call it dishonesty. How many people are not aware of this and pays all these costs out of their own pockets. Fedhealth are most probably saving millions this way. You believe that your medical aid has your best interest at heart but then this happens on various occasions. If it was a singular event i would not have made this statement. I am sure they will rather name or play it as uneducated staff, but for this to happen often it seems like there are quite allot of these "uneducated" staff.

Examples 3 : Terrible Service

Various claims sent on 7 July (7 claims) Claims usually not paid and now already paid by us as medical provider on your back all the time By sending all claims through even if not being paid the can show up on your medical tax certificate and this hugely helps when getting to tax season. Claims still not processed / No reply whatsoever

Example 4 : Are the turning broke??

Treatment date 12/04/2018 Not paid , not paid. After telephonic ally following up they confirmed that the payment was allocated and will run on next payment run. Just receiving another statement today of not paid. Today they don't even have a payment date... Today is 16/07/2018 , how can a specialist not been paid for over 3 months now??? And we are pressured to pay as our ****py medical aid are not responding to the specialist.. This is not acceptable...

And furthermore on this same statement the specialist (anesthetist) will only be paid portion ally. Due to not being on their approved list. HOW ????? If you go in to hospital or emergency,, How are you able to speak for one and ask them not to treat you as you are not on the medical aid list?????? I totally understand this for stand alone or booked specialists as you can phone around and plan your booking accordingly but how do you do this for in hospital treatment??? They don't even provide the option!!!

Just feels like another cheat and short cut to save them money by paying less

We do always require and appoint specialists on the network, Pre authorise and follow the guidelines. Use network GP's etc But even by doing everything right, you will always be at war with this provider