tT
tevinmm T

1 reviews | Active since Jul 2017

22 Sept 2025, 14:13

Fedhealth Refusal to approve Physiotherapy after promised by employee.

I am writing this review with so much emotional and physical pain. If I could give FedHealth 0 stars I would probably do so. My complaint is against the ethics of how FedHealth contact centre is run because their employees feel as though they are doing us a favour by assisting us on our policies and every single employee myself and my mom has dealt with is very rude and arrogant. So I have been with fedhealth for the passed 4 years and I regret every second of it. I struggled getting my plan upgraded for a life changing event after I was given the incorrect processes and needed to provide motivational letter after motivational letter but let me get to the point of the matter. I went for a Acl reconstruction surgery and fedhealth advised that they would only cover a portion of the doctors costs and I would be liable of the out of network hospital fee for using a hospital which is not on that network which I was understanding of and in agreement with. Following the operation I have received exorbitant hospital bills where they are requesting me to pay. Fedhealth has stated on multiple occasions over a recorded line that the entire hospital bill was covered by them and I would only need to pay the out of network hospital cost and the shortfall for my surgeon/specialist. We have asked on multiple occasions for a senior or manager to contact us so that this matter can be sorted but up till today no one has had the decency to call myself or my mother, who has been helping me deal with this matter. Fast forward after the operation was done I was advised by a consultant named Claudine that I would need a letter of motivation again from my surgeon/specialist as well as my physio to be fully covered by FedHealth for my physio for an extra 30 days post op as my physiotherapy started 2 weeks later than it should've. Fedhealth only covers physio for 30 days post op but because my physio was only approved a month after the op she advised that we need to send these letters of motivation to get an extra 30 days approved which we have done and when we called back they told us it can't be done. I am currently at home and not able to do physio and I'm running the risk of not gaining full range of motion back in my knee and leg due to the incompetence of Fedhealth employees. I am holding fedhealth fully liable for any outcome that may be a direct cause of this. She comiited to me being assisted and I will get assisted or I will be reporting this to the ombudsman. We have been calling everyday for the past 2 weeks and no one gets back to us as managers and team leaders are always too busy to contact us. Also might I add that no additional costs were disclosed to us other then the above mentioned by fedhealth or the hospital and the hospital only sent me a statement a month after the operation. If fedhealth doesn't look into this matter I will be taking this further with my attorneys as well.

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Replies (2)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply22 Sept 2025, 14:20
Official
Dear Member,
 
Thank you for submitting your feedback to us, we are sorry to hear about your experience. One of our consultants is already attending to your request and will respond to you shortly. 
 
Best wishes,
Fedhealth


tT
tevinmm T's update22 Sept 2025, 14:49
Reviewer Update
Thank you. I'm addition please also investigate why my mother was advised by your consultants that the entire hospital bill would be and was covered except for the out of network charge of R 13k as the hospital now states the entire bill was not covered. I am writing this to bring it to your attention as I would like to give you an opportunity to sort this out before going to the ombudsman. Please make sure to listen to all the calls thoroughly as we also spoke to another consultant that confirmed telephonically that what Claudine did was incorrect.