Fedhealth medical aid : Unproffesional / unreasonable and unreliable with staff that laughs at you as member

I needed to go for a pain block today. I contacted Fedhealth on the 11th of April 2024 to get the authorization in place.

First of all, The Nappi Codes given through by my Dr Doctor, who would have performed the pain block was: 2800 and 2802. I am on the same plan that I was in 2021, when these codes were used for my previous pain block and both 2800 and 2802 was approved.

Fedhealth approved code 2800, but decided to skip the code 2802 which the doctor gave through and use their own code: 2801, which is actually for an epidural.

Since then they have reprocessed the auth the second time, where code 2800 was approved and 2802 was declined.

After I got a Motivational letter from my Doctor, we handed the request in again and I got an auth on 17 April 2024 where both code 2800 and code 2802 was approved. BUT, then the next day, 18 April, they sent me another auth where they approved the pain block but suddenly, again, declined code 2802.

After this happened I appealed and it was sent through to the medical advisor.

Up until yesterday morning there was no auth decline. No notification of such a decline was received via e-mail (Fedhealth usualy forwards all auth approvals and declines via e-mail). So I confirmed my painblock yesterday with my Doctor and paid my co-payment upfront. I was busy completing my pre-operation form and I needed to fill in the auth number, so I went on Fedhealth's My family room and then only saw that Fedhealth decline my whole procedure.

I phoned Authorization department and the lady I spoke to said, that she will add code 2801 back on the auth (which is for an epidural) which the doctor will not claim obviously and she is going to DECLINE code 2802, which was previously (on all four authorizations) which means I will have to pay everything out of my own pocket). Reason being if code 2800 is approved as per previous four authorizations, and code 2802 is declined still, I would have been able to go ahead with the pain block and just claim the amount due for the 2802 declined code from my Medical Gap Cover. But since she declined 2800 my gap cover will not pay out.

I was angry and told her that how is this reasonable, since on all four previous auths, code 2800 was approved and she said that it shouldn't have been approved in the first place. Although when I spoke to auth department on Tuesday, the other lady said that only code 2802 is a problem.

Secondly, I did not receive an email informing me of the decline, so that is why I confirmed my pain block operation which was due for today and paid over the co-payment amount.

I told her that I want to speak to her manager and she refused, only said she would escalate the matter but not put me through. I then insisted and she still ignored my request. At one stage she started laughing at me, which is HIGHLY unprofessional. I confess that at that stage and after her laughing at me for saying that I will take this further even if I need to contact the medical ombudsman, I snapped and I said that she can laugh all she want, but that karma is a b#tch. I am not proud of this, but I felt and still feel very upset with this whole situation and how Fedhealth handled this matter. Specifically this lady.

I am in a lot of pain due to extreme herniated discs in my neck form C3 - C7. I have to small kids who need me and I looked forward to this pain block just to make my life a bit more bearable.

This lady really does not have any compassion in her and didn't even try being reasonable. I feel Fedhealth service truly has declined over the past few years and wish that I never joined this medical aid. My monthly contribution is sky high, usually including my Medivault savings, it is about almost R12 000 per month and THIS is the LACK of service I am receiving. Fedhealth doesn't care for their members.

My last reference after I spoke to Auth department on Tuesday is: FED***8 and via email ***. I do not have a reference for yesterday's call with the rude lady form Fedhealth Auth department.