NEVER EVER GO NEAR FEDHEATH MEDICAL AID !!

NEVER EVER GO NEAR FEDHEATH MEDICAL AID !!

My wife and I are in our 80's, and pay Fedhealth over R15000/month, having ended up with Fedhealth by default as Topmed bought our Medical Scheme (BEPMED) and then Topmed was bought by Fedheath. We read that SANLAM has now taken over Fedheath and the service has gone from terrible to disgusting (one star is too much) - it should be rankminus 100 (the worst in SA), but there is not that option on Hello Peter.

I have had treatment for both skin and prostate cancer in the past several years and each and every year, when it comes to the time for an annual checkup, it is the same very unpleasant, unhelpful, unsupportive, uncompassionate and excruciating experience trying to get approval for the checkups, for what is a PMB condition.

For those who don't know, Fedhealth doesn't exist in in its own right in any substantive or meaningful way - it sub-contracts everything to an organisation called Medscheme. There is absolutely no one in Fedhealth itself to whom bad service can be escalated, or from whom help can be requested. The CEO is fed with glowing statistics from Medscheme to tell it's members at every AGM, but he, his Board and the small team that work there keep their heads well below the parapet, and they are shielded utterly and completely from their members. SANLAM, the apparent new majority owner should be ashamed of itself.

In any event, its that time of the year again, and on Friday 16th October I spent 50 minutes on the phone to Fedhealth trying to get authorisation to go for an annual skin cancer checkup, based on what Fedheath (actually Medscheme/SANLAM) call my "Oncology Care Plan". Briefly, the experience was as follows:

1.) Call Fedhealth - auto answer music and messages - eventually push "x" for Oncology - ask for help. Ask for approval to go for a skin cancer checkup - read "Oncology Care Plan" - sent another copy by email - OK to see a Dermatiologist/Specialist BUT if they need anything checked - like a scraping or tiny excision of 1 of 100 sun spots/moles - "no can do" - must have pre-authorisation from Authorisations Dept.... but I'm standing butt-naked in front of my Specialist (at R1500/appointment) - sorry, but Oncology doesn't cover that - it will pay for Pathology of a scraping or tiny excision, but not the process! What shall I do? Stop process, go away, get Authorisation and make another appointment with Dermatologist. REALLY - "no can do" - put through to Authorisations Dept.

2.) Authorisations Dept - same story as above - what needs to be done and ICD Codes? I say I don't know, because the Specialist will decide on the spot, based on her live mole scan, what, if anything needs to be done. Sorry, can't help then. Must speak to Customer Care (General Call Centre) to get advice, or Oncology Dept - I say I've just spoken to Oncology - OK put through to Call Centre.

3.) Speak to Call Centre Agent (Virginia). same story related as above. Sorry, can't help - can authorise visit to a Specialist. Give Practice number of my Plastic Surgeon who did my previous skin cancer surgery - given a number which somehow after checking it (after the call), doesn't relate to my specialist. OOps, another problem - my "Oncology Plan" doesn't allow for visiting a Surgeon - must go back to Oncology or Authorisations Dept if anithing needs cutting! Ask for call ref no. and ask to speak to her Manager (call ref 16/10/26/QXVJRM). Told she is not allowed to to transfer me to her Manager - after much debate - they are all at a meeting - I ask to speak to someone else Senior - sorry no one is avalable. Then ask to speak to one of her colleagues - transferred - same story - also, she has to know what I am going to tell the Manager. I say no, can I have your name please - she puts phone down on me.

4.) Phoned my Medical Aid Broker after the call (on Friday 16th) She immediately tried to get hold of someone senior (i.e. above the Call Centre Agents) to call me about trying to get some proper Oncology help and approval/authorisation. As usual everybody was in meetings. 5.) Wednesday 21st October. After a number of calls on Monday and Tuesday by my Medical Aid Broker, somone called Rosa of Medscheme phoned me to apogise for the behaviours of the Call Centre Agents, but she didn't know the full story of initially contacting the Oncology and Authorisation Depts. She listened and promised to come back to me with the answer/approval about getting my annual skin cancer checkup by Friday morning 23rd October 2026.

6) Friday 23rd October - 17h00 - nothing back from Rosa What do I do now - only option is to write to Hello Peter and the Council for Medical Schemes, which I am now doing.

7.) Being Octagerarians, my wife and I are a but "stuck" in a sense, because of the risks involved in trying to change to a Medical Aid that cares, rather than remaining on a "Medical Hinderance".