DON'T CHOOSE FEDHEALTH!!!

Joining Fedhealth Medical Scheme is one of the worst decisions I've made in recent years. I have had tremendous issues with them since inception. I have had to challenge the processing of claims on almost every second claim submitted for the birth and delivery of my twins.

The lack of information provided when you choose to "upgrade" your plan mid-year is astounding, I have fought this to the Executive level and received a response which was so condescending, I choose to ignore it.

They do not inform you, that on the Elect plan, you choose to go on a higher plan which in turn reduces the number of network hospitals you have access to ( where have you ever heard of such ), there is ONE hospital on the network in the ENTIRE KZN province, lmao, goodluck being approved for "emergencies" even though, it was an emergency and the nursing notes confirm it.

Moving on, they now decide on which and which claims they will cover as PMB without any clinical reasons justifying it, I have two claims which needed to be covered in full as per PMB legislation but as you can imagine, they've declined my PMB review without actually providing a reason... interesting! I will wait for the review with the CMS.

My daughter, who was born and admitted immediately to NICU as she had breathing challenges and was on oxygen, they have declined the NICU hospital claim...interesting, reason? Only they know.

Their brochure confirms contraception cover paid from risk, my wife gets an IUD installed, and the claim is rejected because the codes on not on the contraception list, a list which is not easily accessible to me, mind you, I'm not the one that chooses or knows which code the provider is to use, and this is a provider which is on their network, rendering me OOP.

Jesus, I could go on, but what's the point, now it's just about loding the PMB review with the CMS and looking for a better provider.

DON'T CHOOSE FEDHEALTH!!!