Fedhealth poor service and misleading information

Fedhealth take no responsibility for their decisions. It's time that medical aids are held accountable as members really are held at gunpoint by them. The clever way that need to know information is omitted in the vague and communication and feedback. The lack of 'need to know' information, feedback, clarity and flexibility - not to mention empathy. I have been given the run around this whole year, and am back where I started months later. First rock in the road: I attended the Neck and Back Programme, something the appears to be run by Medscheme - as a Fedhealth response to back pain. Fedhealth insists that their members attend this and complete all of the sessions with Physiotherapy and with a Biokineticist. This they say they take on 'risk'. I now realise that while Fedhealth sends its members with back or neck complaints to complete this programme 'at their cost', the real risk and cost is to the member who is put through a programme with the DSP not having any real knowledge of what they are treating. All because Fedhealth will not cover visits to a Neurosurgeon or for Xrays or MRI scans until the Back and Neck Programme, have pushed, pulled and manipulated you to little or no avail. Only then does the doctor there - at this place, write a motivation that a professional consultation with a neurosurgeon be sought. Then at the walk in centre for Fedhealth, I'm advised to go to a Network Neurosurgeon and given a few names to choose from. At no time did the customer service advisor mention that I should ensure the hospital that the neurosurgeon operated from was a Network hospital.

For the record, Fedhealth cover themselves in the sneakiest way with small print that says: "This list is subject to changes during the year. Contact the Fedhealth Customer centre or refer to the website for the latest Fedhealth Grid Network hospital" Not dated, so as a member, we are at the mercy of these charlatans who charge what they want, and even switch DSP as and when they wish - without communication to the members. Be that as it may, I attended the appointment at the DSP Neurosurgeon, went for MRI, went back for consultation and to hear that back surgery was inevitable and with the ongoing deterioration, was the best option and should be done sooner than later. I requested all the required documentation including condition, treatment and quotation from the Dr. Next rock in the road: "request for operation authorisation" Oops - this approved DSP Neurosurgeon doesn't operate at a DSP hospital - bang additional R11,500 co-payment. While this is documented in the options, I honestly didn't even give it a thought as I trusted the information and guidance that I sought on the day I visited the walk-in centre. Not once was it mentioned to ensure the operation is done in a DSP hospital, and this omission of NEED TO KNOW information - is it unfair to expect that this walk-in service that gives members the opportunity to get advise, don't share the whole picture? The next option given to me to avoid the hospital co-payment was to make an appointment with a DSP doctor at a DSP hospital - Waterfall Netcare hospital. That too was a goose chase. The doctor I was told to go see is a Neurologist. This Neurologist told me I should've booked with a Neurosurgeon. Once again, at the mercy of Fedhealth, and relying on their advice. This is costing me a fortune as they only pay for GP's and Dentistry once a member on Fedhealth Flexifed 2 Grid reaches their threshold. Don't be fooled by the book detailing what each option offers - there is a wealth of exclusions that have been cleverly woven into the content, that one doesn't pick up. I've learnt the hard way. I shared this devastating waste of my time and my money with Fedhealth, following their guidance and actually their instruction to go see the DSP specialist at Netcare Waterfall. The next trick from Fedhealth in order to address their poor guidance and advice and a way to delay my required surgery was to instruct me to go to a doctor in Netcare Garden City Clinic - 32 km from my home, as there was a Neurosurgeon who was on the DSP list there. All to 'try help me' avoid paying the R11,500 co-payment on the Hospital admission - a problem that they created for me. I have been in touch with the Dr and await an appointment. Once again, all for my account - Fedhealth doesn't offer any support and in fact haven't even had the decency to advise me if my request for the R12,500 fee be part funded by them. The experience I have had with Fedhealth since speaking to them about my debilitating condition and requirement for back surgery has been horrific. No response to emails, telephone calls, call backs - in fact any communication. Driving to the walk-in centre, makes no sense either as while the advisory consultants are very empathetic and helpful, the back-end of the Fedhealth/Medscheme machine still call the shots - and are ruthless in their interaction and responses. A year down the line, still not resolution or accountability and my condition deteriorates. Having lived with these pinched nerves in my spine for some 11 months now, it's concerning that permanent nerve damage is very possible.

While I give credit where credit is due. If you have been diagnosed with a dread disease, or one of what fedhealth call a condition on the chronic condition list, and/or are on one of their premium medical aid options, the service is vastly different to this experience. It's all about the money.

ADVICE TO MEMBERS - Learn from this very expensive, painful and frustrating experience that Fedhealth put members on the FlexiFed 2 Grid option through. A crippling experience and still, no assistance in my need for surgery. If this is the way medical aids operate, bring on the National Health System - urgently.