MM
Mark M

1 reviews | Active since Jun 2021

10 Nov 2021, 13:22

Fedhealth approved procedure not paid in full

I had stomach pains so went for tests and was diagnosed with a umbilical hernia. My procedure was authorized for 22nd of june 2021. I had a co payment of R6800 which i made on admission. Surgery was done a prosthesis mesh was used. September 20th 2021 i received a call from the hospital stating i am have a balance of R4998 due by me because medical aid didn't pay for the prosthesis used. I contacted fedhealth and was told by the consultant that theres a mistake and i must not worried everything will be sorted out with the hospital. They will ask hospital to re submit the claim because it was an aproved procedure. 10th of November 2021 i received an email from netcare final demand of payment. Fedhealth says prosthesis limit exceeded and is going to change it to pmb or pms for payment. To date and time nothing has been done. This medical aid has to be the worst of my experiences.

0
Replies (5)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply10 Nov 2021, 13:44
Official
Dear Member, 
 
Thank you so much for your message, we are sorry you’re having such a bad experience, please bear with us while we do some investigating.  One of our consultants will be in touch with you as soon as we have a result. 
 
Best Wishes
Fedhealth

MM
Mark M's update10 Nov 2021, 13:54
Reviewer Update
Thanks for the response. Will be awaiting there call since i have tried many times claims department authorization depart as well as customer care
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply17 Nov 2021, 10:22
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards 
The Fedhealth Family

MM
Mark M's update13 Jan 2022, 21:10
Reviewer Update
Thanks Fedhealth everything was sorted out and claim has been paid. Much appreciated by the quick response and action.
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply04 Aug 2023, 10:07
Official
Thank you for your feedback.  

Best wishes, 
Fedhealth