Fedhealth - Authorises claims and then don't pay them. Extremely disappointing

In the beginning of the year my son had to have some dentistry work done and since he's only 7 the dentist advised that on young kids they normally do it under anesthetics as it can be quite traumatic. I then proceeded to get authorisations which after many backwards and forwards was approved but with an R11K co-payment due to it not being at a network provider. Since the co-payment was just too high I told the dentist that we will need to postpone, until such time they are able to assist at a network day clinic.

At the end of June I contacted the dentist again and they advised that they were now able to do the procedure at the Berg Day Clinic which is a network provider. I then proceeded to get authorisation again and this time the procedure was completely authorised. An authorisation letter was received indicating the various procedure codes and all was shown as approved.

Soon after I received the bill from the dentist showing that Fedhealth only paid R408 of the R3500 bill and they not paying the rest due to insufficient funds. After and hour call with Fedhealth they advise that even though the claim was authorised the dentistry is covered from my savings and since there was very little savings only the R408 odd was paid.

I find it extremely frustrating and very underhanded that this was not mentioned when the authorisation was done and sent, especially since when I did the authorisation in Jan the lettter advised that there would be a co-payment so why when I did the authorisation in June for the 1st of July was I not informed of the fact that the dentistry will be from my savings. And to add injury to insult, they did not even pay the full claim from the Clinic, which is on THEIR network provider list.

I am extremely disappointed in Fedhealth over the last 2 years they have gone from a medical aid that was about helping their members to one that seemingly does things underhandedly and shady. It's coming to year end and I highly doubt whether I will be staying on with them and certainly would not advise anyone to join either.