AE
Alisha E

1 reviews | Active since Nov 2021

08 Sept 2023, 13:58

Paying insurance for a benefit I have but can not use

I called Fedhealth wanting an answer on my hospital authorization that I sent through on the 4th of September. No response was given so I thought I would follow up with them. I was transferred to 7 different people in the organization. The first person told me that the claim was already paid in full. The 4th person told me that the surgery was scheduled for Monday (I was not given a date by my dentist). Eventually I asked to speak to a manager as this was really horrible service and I had spent quite a bit of money trying to follow up on a request that they should have responded to. I was again put on hold and after 4 mins I was told that the team leader is on a call and will call me back. After a few hours I called again and low and behold I get a declinature to my entire procedure which included a simple tooth extraction. The reason for the declinature was not based on policy wording but rather that the department doesn't deal with this type of authorization. In die end I have paid for a benefit that I am covered for but can not use because the department doesn't deal with it. Pathetic.

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Replies (3)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply08 Sept 2023, 14:26
Official
Dear Member
 
Thank you for submitting your feedback to us, we are sorry to hear about your experience. One of our consultants will contact you to discuss your enquiry. 
 
Best wishes,
Fedhealth 
AE
Alisha E's update08 Sept 2023, 16:02
Reviewer Update
Good day Fedhealth,

I have been waiting since 12:45 for a manager to give me a call and I am still waiting. Is there an ETA for this phone call to take place?

Regards,
Alisha Esterhuizen
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply08 Sept 2023, 16:41
Official
Dear Member
 
Our executive consultant has made contact and further updates will be provided to you on your case as discussed. 
 
Best wishes,
Fedhealth