FedHealth Falsely Accused me of Non-disclosure and each escalation ends up at one person!!!

FedHealth Medical Scheme Falsely accused me of non-disclosure and is rejecting my Maternity benefits in Full!!!

I have tried my very best to escalate the matter but it seems that only one person named Ricardo Ganesan has handled the claim and he continues to reject the claim with no explanation or willingness to discuss the issue with myself although I have sent through proof that I was not pregnant when I initially filled in my documents on 15th December 2021, proof that I had reason not to know I was pregnant until I let them know via a letter from my doctor as well as proof of when I saw the Doctor and contacted the broker within 36hours of seeing my doctor.

Below is a detailed description, if you could kindly take the time to read through:

Around November 2021 I contacted an agent working at Curemed to assist me with advice with regards to becoming a member of a medical aid.

We discussed some options and she sent me information in mid-November 2021.

Before the date of 13/12/2021 I requested that we move forward with Fedhealth medical aid as well as gap cover On 13/12/2021 the Curemed agent sent me all the documentation to fill in. On 15/12/2021 I sent my filled in Documentation and application On 15/12/2022 I received an email stating that I had to send documents through which included my proof of residence, bank statements and payslips before 15/12/2022 as they were closing that day. Due to the short notice of Curemed closure I was unable to send through all the documents on time. On 11/01/2022 I called Curemed to let them know I had my documentation but the agent was still on leave at the time. On 31/01/2022 I send an email with my copy of I.D., Proof of residence, pay slips and 3months bank statements. On 31/01/2022 I then received an automated reply from Curemed that the agent was on training was on training and I immediately emailed admin3@curemed with all my documents as well as payslips stating that I was urgently wanting to finalize my medical aid. 0n 01/02/2022 I received an email from the Curemed agent stating that an additional signature was still required on my documents which I immediately signed and sent back. I then read through the document and saw that the agent had refilled a new document from the document I had filled in on 15/12/2022 but had made a few errors (for example that I was male not female), I rep**** with a request to change the errors. Om 02/02/2022 I received a number of emails from the agent and we finally finalized my Medical Aid. I was told I would have to wait until March 2022 until I could be on the medical aid scheme and as I did not know I was pregnant at the time one month seemed to make very little difference. (Telephonic conversations in this regard can be obtained from Curemed as proof)

My application was sent from what I understand to Fedhealth on 15/12/2022 and then my personal documents required on 31/01/2022 and then my finalized signed document on 02/02/2022

As I have experienced irregular monthly cycles all my life and I was told I would likely struggle very much to fall pregnant due to this, I would likely require a fertility specialist. I for the first time visited a fertility specialist in 2020 where my condition remained the same. At the time I was due to get married in over a year and a half and my husband and myself had discussed that we would be married a few years before trying for a child. I opted to not receive any treatment in regards to fertility nor was I planning on getting help before 2024 to fall pregnant. Due to this the specialist had told me to only revisit him when I was trying to fall pregnant and instead in two years’ time visit his refereed gynaecologist Dr Venter as due to my issues I should go every 2 years at least for a check-up. Thus I went for my 2 yearly check-up to Gynaecologist Dr Venter on 28/02/2022, two years after my previous visit in 2020 where my irregular cycle had not changed and I elected to not to anything regarding my fertility at the time. On 02/28/2022 Dr Venter the Gynaecologist informed me that I was pregnant. I have attached a letter from my Doctor verifying that all the above information is correct.

I began with the process of signing up with Curemed as a broker for Fedhealth mid December 2021 before I fell pregnant. All relevant documentation that I was aware needed to be completed had been send to Curemed on 31/01/2022 and then the final correctly changed document was sent on 02/02/2022. From what I understood Curemed had already submitted everything to Fedhealth on 02/02/2022 which is 26days before I knew that I was pregnant. Within 36 hours of seeing Dr Venter I contacted the agent from Curemed and informed her that I had just found out I was pregnant and she ensured me she would take the necessary steps with FedHealth so that we can move forward with having my maternity fees covered.

I contacted Curemed as well as FedHealth and was constantly told my maternity application was under revision.

On 12 April (2 months later) I received the letter from FedHealth indicating that it was a non- disclosure from my side which is not the case. I was definitely not pregnant when I started the whole process of applying for membership to a Medical aid.

I immediacy contacted FedHealth as non-disclosure was not the case but I was sent through to a general agent who tried to help me by personally speaking to Ricardo Ganesan and she had informed me that he had made his decision and this was absolutely final and that he was not able to discuss this with me personally. I was given absolutely no way of moving past him and his opinion that this was a case of non-disclosure. As I knew that this was not a fact and I felt I was able to prove differently I contacted Curemed again. They put me through to a Mike Fullard who is an Operational Manager, after revising my case he felt that there was enough proof that this was not a non-disclosure case. He did his absolute best by sending all my proof through FedHealth including voice conversations. This was once again handled by Ricardo Ganesan who rep****, “Please note that management has reviewed the decision and the underwriting will remain.” Someone named Jannus Van Der Walt from FedHealth themselves felt that this was an extremely vague response and that he did not give enough of a reasoning. He query on this was responded with stating that it was based on the underwriting due to point 19 in the terms and conditions which is the following: “I acknowledge that it is my responsibility to notify the Scheme of any changes to the facts, or any changes in my or my dependant’s state of health, between the date of signing this application form and the date when my membership commences. If this is not done before my membership commences, waiting periods may apply and/or future claims or my membership may be rejected”.

This clause is absolutely not a valid reason as I absolutely contacted Curemed the within 36hours of seeing the doctor for the first time and I was promised that the agent would immediately contact FedHealth. She ensured me that she contacted them immediately. So as far as I am concerned this is absolutely not correct or reasoning to deny my maternity benefits. I was told by Curemed that they have done their best but advised to take this further.