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Nadine R

1 reviews | Active since Feb 2018

03 May 2023, 02:48

Error made on the Fedhealth system is costing me

I recently went in for a c-section and the anesthesiologist's claim was split into 5 items. The medical aid approved all items, but instead of splitting the partially paid amount across all 5 items, it was only split between 3. So one of the 5 items seemed like it was paid in full and even more than what he service provider asked for, while two of the 5 items does not have any amount next to it.

Now the gap cover that Fedhealth suggested, Sanlam gap cover (kaelo) is not approving the two remaining claim items, since it "wasn't approved". Even after explaining and asking Fedhealth to correctly split the amount between ALL items and not group together partially paid amounts, they just gave me a gap cover letter that Sanlam dies jot use as their main source of information and looks at the Fedhealth system directly.

Now I have to pay R7k for a mistake that Fedhealth made and lack of communication between Fedhealth and the gap cover they suggested.

Then I also need to mention that the first gap cover letter weren't even relating to me and they shared another Fedhealth member's details with me...which is really concerning, since my information was probably sent to this member.

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply03 May 2023, 05:56
Official
Dear Nadine Rossouw,

Thank you for submitting your feedback to us, we are sorry to hear about your experience. You have reached us outside of our working hours which is 08:00-16:00 Monday to Friday. One of our consultants will contact you this morning to discuss your enquiry.

Best wishes,
Fedhealth