Fedhealth Refusing to Cover Eye Test – Charged R3000 Unfairly

I am formally raising a serious complaint against Fedhealth regarding the handling of my recent claim.

On 26 February 2026, I underwent a comprehensive eye test, a benefit that is explicitly covered under my plan. Prior to the consultation, the optometrist’s office confirmed my benefits with Fedhealth. Following the examination, I was advised that my eyesight is normal and that no corrective materials were required.

I was subsequently billed in excess of R3000, with Fedhealth declining the claim on the basis that no materials (such as glasses) were issued. This interpretation is unreasonable and inconsistent with the purpose of a comprehensive eye test, which is to assess the need for corrective intervention—not to guarantee that such intervention will be prescribed.

Despite multiple engagements with Fedhealth, I have received only generic responses that fail to adequately address the substance of my query. No clear, detailed, or comprehensible justification has been provided for the rejection of this claim.

Should this matter not be resolved promptly, I will proceed with a formal complaint to the Council for Medical Schemes and explore all available avenues for recourse. I will also consider raising this issue with relevant regulatory bodies, as well as pursuing further action where necessary.

I require an urgent, written explanation and a full reassessment of this claim.