Formal Complaint Regarding Denial of Access to Healthcare Services

Item: Fedhealth Medical Scheme
Rating: 1
Author: Francois F

I am writing to formally lodge a complaint against Fedhealth regarding the handling of my medical aid benefits and the serious impact this is currently having on my health.

Firstly, at the time of joining, I was explicitly informed by the broker that I would be able to make use of a specific hospital within your network. Based on this information, I made my decision to join Fedhealth. It is therefore completely unacceptable that I am now being informed that I may not use the very same hospital when I urgently require admission.

Secondly, I am currently in need of immediate hospital admission due to ongoing and worsening medical symptoms. A doctor has recommended that I be admitted for further investigation, including scans. However, I am now being denied access to the hospital network that I was originally advised I could use.

Thirdly, I have been informed that I need to wait up to three days for authorisation. This delay is unreasonable and poses a direct risk to my health. At no point was I informed that such delays could occur, nor that access to necessary healthcare services could be restricted in this manner. As a result, I am effectively being denied timely medical treatment while my condition continues to deteriorate.

This situation raises serious concerns in terms of my rights as a member. In terms of the Medical Schemes Act 131 of 1998 and the principles set out by the Council for Medical Schemes, members are entitled to access healthcare services without undue delay, especially in cases where medical necessity has been established by a healthcare professional. Furthermore, any misrepresentation at the point of sale, whether by a broker or representative, is unacceptable and constitutes a breach of fair practice.

I request the following as a matter of urgency:

Immediate authorisation for hospital admission at an appropriate facility within your network or approval for the recommended facility A full written explanation as to why I am now being denied access to the hospital I was advised I could use Clarification on the authorisation process and why this delay was not disclosed upfront Immediate intervention to ensure that I receive the necessary medical care without further delay

Should this matter not be resolved urgently, I will have no choice but to escalate this complaint to the CMS and pursue further action.

I trust that this matter will receive the urgent attention it requires.

Kind regards Francois Pretorius

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Replies (2)

Fedhealth Medical Scheme's replyOfficial

05 May 2026, 08:07

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

Fedhealth Medical Scheme's reply05 May 2026, 08:07

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

Francois F's updateReviewer Update

06 May 2026, 17:09

Dear Fedhealth Complaints Department,

I refer to my ongoing complaint and write to urgently escalate the current situation.

I have now been informed that forms are being sent to previous doctors to assess potential pre-existing conditions. This process was never disclosed to me at the time of joining, nor was I informed that my access to care could be delayed in this manner.

Furthermore, I have been advised that my membership may be suspended if these forms are not completed within three days. This is entirely unreasonable, as the completion and return of such documents are outside of my direct control. Despite this, I am being prejudiced and denied access to necessary medical care.

I must also express my dissatisfaction with the manner in which this matter has been handled by your staff. The communication and support received have been unprofessional and unhelpful, which has further added to the stress of an already urgent medical situation.

This delay is unacceptable and is directly affecting my health.

In terms of the Consumer Protection Act 68 of 2008, I am entitled to fair, reasonable and timely service, as well as to information that is not misleading.

Given the above, I demand immediate intervention to prevent any suspension of my membership, urgent assistance to ensure that my case is processed without further delay, and full written clarification of this process and why it was not disclosed.

Please take note that should this matter not be resolved immediately, I will proceed with formally lodging complaints with the Council for Medical Schemes and the National Consumer Commission.

I expect urgent written feedback.

Kind regards,
Francois Pretorius

Francois F's update06 May 2026, 17:09

Reviewer Update