Every claim has to be fought for

<p>A hospital plan is to assist you when you need urgent medical care, so I chose the top Fedhealth Hospital Plan which is also the most expensive. I never needed to claim for 9 years but faithfully paid every month.</p> <p>Then on the long weekend at the end of April I fractured my ankle on a hiking excursion. I live 110km from the nearest X ray facility and undertook the journey in excruciating pain. My ankle was X rayed and confirmed a fracture which the kind surgeon coming in on a Sunday of a long weekend agreed to operate on as I live so far from the hospital.</p> <p>I phoned Fedhealth authorization straight away to find out what to do and received a voice mail stating that the service is not available but in no way will my claim be affected by that. I did send an email as well.</p> <p>I was operated on that same Sunday afternoon and discharged the following day so happy that I have kept up my medical aid payments and Fedhealth claims "Family take care of family".</p> <p>Then I received a response that they will not pay anything of the doctors' account. I felt sick to the stomach as I couldn't believe it. The reasons are given in code and as I understood it was that I did not get authorization and the specialist was not a preferred supplier. I made it clear that I tried all I possibly could under difficult circumstances and couldn't get authorization or information. They paid about 10% of the claim. I then claimed it as a "PMB" case as it was. After 6 weeks they paid the surgeon, but not the anaethetist for the same reasons they did not pay the surgeon initially.</p> <p>I have sent mails repeatedly and do not even get a response. It is a PMB case and I have my legal rights for the claim to be paid. The Aneathetist is now threatening to hand my account over as rightfully he needs his money for a service performed. I just want answers and reasons so I know the way forward. It would have been more profitable for me to save the monthly premiums than to pay Fedhealth. </p>