AK
Amod K

1 reviews | Active since Feb 2021

29 Aug 2025, 09:15

FEDHEALTH *******

I am on a myfed plan this plan covers chronic conditions under a PMB plan which allows me 2 consults with a cardiologist. It also allows 2 specialist visits per family from savings. due to a knee injury i was taken to an emergency room and had x rays done fedhealth will not pay for the xrays .Their reason is that I was not admitted and it was not a trauma as per their definition. I now need to consult an orthopeadic and they claim that i have used up my specialist consults by going for my cardiologist check up. i spoke to a consultant who agreed that the cardiologist visit is part of the PMB treatment plan and should be paid as such and not from the savings. He submitted the accounts for review. The response after the review is "assessing department confirmed that the claim is correct as the claim is out of hospital even though the consultations is approved on the care plan. this is a BS excuse because they will not approve a hospital stay for a general cardiac check up. I AM NOW SITTING UNABLE TO WORK OR WALK WAITING FOR THEM TO MAKE MY FUNDS AVAILABLE TO SEE THE ORTHOPEDIC.

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply29 Aug 2025, 10:47
Official
Dear Member,
 
Thank you for submitting your feedback to us, we are sorry to hear about your experience. One of our consultants is already attending to your request and will respond to you shortly. 
 
Best wishes,
Fedhealth