Pathetic service by Fedhealth

My membership with Fedhealth Medical Scheme go as far back as 17 years. I joined Fedhealth in 2004 and never used any of the benefits under my scheme option until January 2021 when I was diagnosed with Rheumatoid Arthritis and finally was registered under the chronic benefit.

However, since the diagnosis my health situation has deteriorated to the extend that I am in need of an urgent hip replacement operation. I have done the following since the urgent need for surgery was identified by the orthopedic specialist:

1. I have forwarded to Fedhealth an urgent request, supporting documents and specialist motivation for a scheme upgrade as required in terms of the 30 day rule , within 30 days in order for the urgent operation to be authorized under the higher option.

2. The following email was sent to me today by one of the fedhealth representatives dealing with my matter:

Please be advised that unfortunately the Fedhealth Fund Manager has declined your request to upgrade, I did appeal it however he has still declined it due to the fact that you were diagnosed in February with Rheumatoid Arthritis having a problem with your knees, Fedhealth allows upgrade within 30 days of diagnosis. The diagnosis is still Rheumatoid Arthritis and it is not a new diagnosis even though the deterioration of the hip is new. As per the scheme rules you should have upgraded in February whether it was for your knees or your hips. You have an opportunity to upgrade in Jan 2022 to a higher option.

3. The flaws in the response are so far and wide that it would take me another 10 hellopeter reviews to reflect on the poor judgment that was app**** by those who made the final decision regarding this matter.

4. Is this the manner in which fedhealth treat those long standing members who paid faithfully every single medical aid contribution for the last 17years?

5. I was only informed of the so called "30 day upgrade rule" when I enquired about the possibility of upgrade to a higher plan with more benefits. I am yet to be sent the scheme rules that stipulate the terms and conditions that apply to this rule. Safe to say it is not available in the fedhealth family room or anywhere else.

6. Fedhealth never took my unique situation into consideration whilst considering my request for an option change, nor was I informed in February 2021 when I app**** for the Chronic benefit that I will need to upgrade to a higher option. Considering that no one not even the specialist could have foreseen that I would require urgent surgery in August 2021.

7. The deterioration of my hip was due to the Rheumatoid Arthritis but was only presented as a problem recently and the need for an operation identified less than 30 days ago. I have comp**** with the requirement of a "life changing event" by informing and requesting Fedhealth to upgrade my scheme option. I further submitted all required information and documentation in line with what was requested by Fedhealth in this regard.

Fedhealth your service to long standing members is pathetic.