Fedhealth is an absolute joke of a medical scheme

I really hoped I wasn't going to have to leave this review, but I have no choice at this stage. It seems to be one of the only ways to get Fedhealth to do anything.

If you're looking at these reviews to choose a medical aid, here are some things you should know off the bat: 1. Fedhealth does not answer emails 2. Fedhealth will take weeks to approve a pre-authorisation request if you don't phone the call center every day for updates. 3. Fedhealth will try to not pay for claims they have to pay for, I assume in the hopes you will just do it and go away. 4. Fedhealth's "Family room" and member app do not function. Half of the pages (claims, benefits, statements, provider search, etc.) are literally blank, and haven't worked for months, if not years at this point. 5. The only way to find out any information, provider lists, or get anything done with your policy is to contact customer support. Like we're living in 1985 and not 2023. Naturally, this means you can't get any help on anything outside work hours.

As for the issue at hand. I had my impacted wisdom teeth removed on the 11th of Jan. Surgical removal of impacted wisdom teeth is a covered procedure from the in-hospital benefit, with a R5100 co-payment, and a shortfall you have to pay for the anesthetist if they charge more than Fedhealth's rate. Cool, I made sure I was aware of all of this beforehand. There are no additional co-payments unless you use a non-network surgeon or a non-network doctor. Of course, I made sure to use network everything.

From the 13th of Jan when the claims all came through from my surgeon, the hospital and the anesthetist, there have been literally endless issues. To date, 26% of the total bill has been paid to providers, including my R5100 co-payment. Initially, I contacted customer support to find out why the claim from my surgeon hadn't been paid. I was told there was an IT issue where my authorisation number wasn't linking to the claim. Then, a few days later, I queried again, and started being told the surgeon's fees are paid from available savings and I don't have any savings. This is obviously ridiculous as it's a covered procedure from in-hospital benefits. It did not however stop the assessor from claiming this was the case, and multiple customer service agents, on phone and online, very rudely telling me so too. Only once I started sending screenshots of their own benefit guides and annexures, where it clearly states it's a covered procedure, and the surgery is covered from risk, was I finally allowed to escalate the claim to be re-assessed. This was about a week after my surgery. I was given a reference number for this escalation (190123QH2THB).

Since then, I have not once again been told the claims are subject to savings. There has, however, been some "IT issue" requiring "ResQ calls" that just never goes anywhere or gets resolved. I imagine the same IT issue I was told about the first time I queried why my surgeon's claim was rejected. I have followed up with this reference number 2-3 times a week for FIVE WEEKS now, and not a single thing has been resolved. I have been told it has been escalated to the highest level more than 6 times. According to Fedhealth's own scheme rules, they are meant to pay providers within 30 days. Currently, I am sitting with doctor's rooms hounding me for money the scheme is liable for, and exactly zero progress being made. How difficult can it possibly be to make sure an authorisation number links to a claim correctly? Do you even have an IT department, or do these requests just go to nowhere?

Second issue. My anesthetist has been paid R1200 of his R6000 bill. My brother is on the same plan as me, and had the same surgery as me in June of 2021. His anesthetist was paid R2460. I want answers on this discrepancy. The amount my anesthetist was paid is clearly too low and not Fedhealth's rate, and no one has been able to give me answers on this. I need to know how much to pay as a shortfall, but no one can tell me why what has been paid is so low.

I have been SO patient. It has been more than 40 days that I have been waiting and following up and waiting and following up. I am yet to receive a single email about the matter. I was told on Tuesday this week someone would be phoning me to discuss this matter because I had been waiting so long with no resolution.

How do you run a medical aid like this? I shudder to think of all the poor people with PMB, chronic and life-threatening issues who likely get treated with the same lack of respect and urgency by Fedhealth.