TM
Tazz M

1 reviews | Active since Nov 2011

18 Aug 2015, 17:32

Fed refuses to pay claims for 10 year old heart

My 10 year old son fainted at school and complained of chest pains. With his history of having had an ASD repair at aged 3, I rushed him to Unitas hospital ER. After running a series of tests which established slight swelling of his heart, the ER doctor gave us a referral letter and sent us to the paediatric cardiologist. The cardiologist ran a series of tests and gave him a halter 24 hour heart monitor which needed to be removed today. She informed us that we needed to take him for a stress ECG tomorrow. I initially called in and spoke to Sharon who informed me that the ER and cardiologist would be linked and paid since I had called in for authorisation. All I had to do was obtain procedure and ICD 10 codes. I obtained these codes and called back and spoke to Anita. She completed the file and then informed me that in room procedures would not be covered since my savings were depleted. This is unacceptable. I pay an enormous sum through to fedhealth monthly and dont frequently submit claims. My son is 10 years old. Do I need to wait for him to have heart failure and be admitted before fedhealth will give a damn? With his history shouldn't it be paid out of risk? I need help!!

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply19 Aug 2015, 12:33
Official
Hello Tazzmoosa,

Thank you for your comment. Please allow us to investigate the matter in more detail. We will be in touch soonest.

Kind Regards
The Fedhealth Online Team