Ill-Equipped Call Centre Consultants and Lack of Feedback from FedHealth

On or about 29 June 2020, I had contacted the FedHealth Call Centre to enquire about a possible upgrade to my current plan due to pregnancy. The said consultant that I spoke to mentioned that there was a 30 day deadline to be able to upgrade. I had mentioned to the said consultant that I was already 3 days out of the 30 day deadline, However, she advised that I could still send through an application to the Medical Aid for consideration and subsequently sent me an Application Form to complete.

I completed and emailed the application form back to FedHealth on or about 29 June 2020 mentioning "pregnancy" as the reason in the email.

On or about 2 July 2020, FedHealth responded by requesting "motivation" to my application and a letter from my Gynaecologist was drafted and sent through on or about 7 July 2020.

On or about 13 July 2020, I had called the FedHealth Call Centre to enquire whether there was any feedback regarding the upgrade. The said consultant that I spoke to mentioned that my application form was in "one place" and the motivation letter was in "another" and he kindly combined the application form and motivational letter as one complete document. I was given the query number of: 290620Q2FJ7N for this call.

On or about 17 July 2020, again, I had to call FedHealth Call Centre to enquire if there was any feedback regarding the upgrade. The said consultant mentioned that there had already been a decision made approximately two days prior. I questioned why I had not been notified and why I find myself in a position where I am the one who has to follow up continuously.

Nevertheless, the said consultant mentioned that an outcome had been reached and that I was unable to upgrade my medical aid as I had fallen outside of the 30 day period. I questioned this as the initial consultant (the call made on 29 June 2020) knew this as I had told it to her. However, she still sent me an application form to complete.

If 30 days was the sole determiner of upgrading my medical aid, why did she not mention this to me and why did she still send me an application form to complete even though I told her I was out of the 30 day period?

I requested that the call be listened to (the call made on 29 June 2020) so that there could be verification made of what I was saying. I also requested that I receive feedback from a Supervisor regarding this matter.

On or about 17 July 2020, feedback was given via email (Query number: 290620Q2DTNB) mentioning that: 'The agent told you that if the diagnosis date of the life changing event (pregnancy) was over 30 days, unfortunately we won't be able to approve your option change request.' - as quoted.

I subsequently knew that the consultant also said that I could send through my application form, despite being outside of the 30 day period and henceforth requested for the call to be sent to me.

On or about 20 July 2020, I called FedHealth, again, to request such call recording to be sent to me. The consultant I spoke to advised me that it would take a couple days to be sent. I questioned this as I had been told on Friday, 17 July 2020, that the consultant's Supervisor had listened to the call. Why did I have to wait a couple of days to listen to a call that a Supervisor had listened to on Friday, 17 July?

The consultant said that he would have the Supervisor contact me regarding this matter. I have the following reference for this call (20020Q39FTW).

The Supervisor contacted me, on or about 20 July 2020, where again I requested for the call recording. He mentioned that the call could not be sent, however, a transcript of the call could be sent. I had just been told that the call would take a couple of days to be sent by a consultant and now I was being told only the call script could be sent.

I shared my frustration with the Supervisor and he agreed that this whole matter could have been avoided had the initial consultant (the one contacted on 29 June 2020) told me that I could not upgrade my medical aid because the sole determiner was the 30 day period. He also apologized for the hassle that I have had to endure.

My complaint is thus:

Why did the initial consultant allow me to apply to upgrade my Medical Aid if the sole determiner was 30 days and resultantly send me an application form? Why did a consultant mention to me that I have to wait a few days to receive a call recording when the Supervisor told me that I could not receive any call recording?

I also wanted to know what will happen to the said employee who I spoke to on 29 June 2020 who gave me incorrect information, wasted my time and resources? I continuously had to call and follow up through the FedHealth Call Centre and be thrown from pillar to post regarding this matter.

I furthermore feel that consultants are ill-equipped to answer questions that members might have - as seen how I have been given incorrect information on two instances.

I have sent an email to FedHealth with a complaint. I called on 27 July 2020 to enquire if there was any feedback regarding the complaint sent. The said consultant mentioned that the matter has been dealt with - according to what she could see.