Poor service

To: Fedhealth Medical Aid From: Marika Crous Membership No: *** Date: 27 April 2025

Subject: Formal Complaint Regarding Service and Treatment Delays

Dear Sir/Madam,

I hope this letter finds you well. I am writing to formally address a series of concerns regarding my membership, application process, service received, and the most recent issue involving the delay in authorisation for necessary medical treatment. Please allow me to outline the key events and the issues I have encountered.

1. Membership Application (January 2025) - *** I app**** for membership with Fedhealth on 8 January 2025, through an agent named Thato. My application was processed and I received an official welcome email on 14 January, confirming that my membership started from 01 January 2025. However, my concerns began with the handling of my medical history and the subsequent delays in receiving care.

2. Medical History Disclosure & Headache Diagnosis On 10 January 2025, I consulted with Dr. Pillay regarding ongoing headaches that I had been experiencing for over a year. I paid for the consultation and a scan out of pocket, as I was not yet a member of any medical aid. The scan revealed that I had Idiopathic Intracranial Hypertension.

On 13 January 2025, I called Thato to disclose this information, ensuring that Fedhealth was aware of my condition for future reference. I also forwarded the scan report.

3. Membership Acceptance and Questionnaire After my membership was confirmed, Fedhealth sent me a questionnaire on 20 January 2025, requesting further information. I was confused as to why this information was being requested after my membership was already activated. Shouldn’t this have been part of the application process? The delay in completing these questions led to a suspension of my membership on 29 January 2025 due to lack of response.

4. Suspension and Unclear Authorisation Process After I answered the medical history questions on 29 January 2025, I was informed that there was an authorisation request for the consultation and scan. However, when I contacted Fedhealth, no one could clarify what this authorization was for, as I had never requested any authorisation for these procedures. Eventually, my suspension was lifted on 6 February 2025.

5. Termination Due to Non-Disclosure On 24 February 2025, I was informed via email that my membership was terminated because I allegedly failed to disclose that I used over-the-counter pain medication for my headaches. I want to point out that I had disclosed my diagnosis and chronic conditions, as was required. Additionally, when I contacted Fedhealth, an agent explained that only chronic medications and confirmed diagnoses needed to be disclosed. The agent was unable to even understand basic medical terminology, which I found highly unprofessional. How can a medical aid have agents answering calls who are not fami**** with medical terms?

6. Unauthorised Kidney Stone Treatment (April 2025) On Sunday, 20 April 2025, I experienced severe pain in my lower back, which was later identified as a kidney stone. I contacted Dr. Pillay, and after a CT scan, it was confirmed that I needed urgent treatment. The urologist, Dr. Pretorius, contacted Fedhealth multiple times for authorisation for the procedure, but I was told that the request was under review by the underwriters, with a waiting period of 3 days. The pain was unbearable, and as I was not receiving timely assistance from Fedhealth, I decided to pay for the procedure out of pocket to alleviate my suffering.

7. Poor Service & Rude Agent Interaction On 25 April 2025, I contacted Fedhealth to follow up on the status of the authorisation for the kidney stone procedure. I spoke with an agent named Palesa, who was extremely rude when I asked if there was any outcome. She informed me that the authorisation was declined due to a 3-month waiting period, which I find unreasonable for a condition requiring urgent treatment. When I expressed my frustration and concern, she abruptly dropped the call. This behavior was not only unprofessional but also added to my distress during an already difficult time.

8. Questionnaire Request Following this, I received another questionnaire regarding my medical history, which only added to my confusion and frustration given the urgent nature of my situation.

Conclusion & Request for Immediate Action I would like to stress that my situation involves urgent medical conditions that require immediate attention. I find it unacceptable that Fedhealth has delayed or denied authorisation for critical treatments, especially when the necessary information has been provided. The service I have received from Fedhealth has been extremely poor, particularly in times of need.

It is difficult to believe that a medical condition like a kidney stone, which is unexpected and painful, could be subject to a waiting period or be treated as a non-urgent matter.

I am extremely disappointed with the quality of service provided by Fedhealth, particularly during times of urgent need. Additionally, I have not received any phone calls, despite being informed that Fedhealth attempted to contact me. I would like to request that you use the alternative contact number: ***.

I am formally requesting the following:

An explanation for the lack of timely authorisation for my kidney stone procedure and the subsequent pain management.

A review of the manner in which my membership was handled, especially regarding the termination and reactivation of my membership.

A formal apology for the rude and unprofessional behavior exhibited by your agent, Palesa.

Immediate attention to my current medical needs, including the urgent care and treatment for my kidney stone.

I trust you will treat this matter with the urgency and seriousness it deserves. I would appreciate a prompt response and resolution of the issues raised.

Thank you for your attention to this matter.

Yours sincerely, Marika Crous Membership No: *** ID Number: *** ***