EG
Emma G

1 reviews | Active since Apr 2014

26 Feb 2018, 12:54

Refusal to pay claim and useless call centre staff

On the 28th of December I had to visit my GP and my claim was rejected. This visit was within my yearly plan and with the same doctor, I have been seeing for years now. I cannot begin to with the frustration and anger that has gone into trying to claim back a pathetic R375. I contacted Fedhealth repeatedly to get help with this claim. I spoke to 3 different people and I was once put on hold for 30 minutes. I wasn’t paying for this call and I was interested to see if I would actually get help. I did not and eventually hung up. I had to send another message for a call back for help and since then I have received 2 calls that have been beyond pointless. I am called by these general call centre staff who cannot seem to go beyond reading the screen prompts. Each time as I am trying to explain my problem, they stop me and preach to me about the limits of my plan. It is automated at this point. Becuase from here is where I lose them as it is out of their jurisdiction from what I can tell. I ask to be put through to the claims department, who are hopefully more competitant, and that hasn’t happened. It is the end of February and I haven’t spoken to anyone who is even able to understand or willing to try and listen to me without reading from their computer screen. All they tell me is that my day-to-day has been exceeded and that my doctor is not nominated. I then have to tell them, which is amazing because they should know this, that GP visits are free on my scheme once the day-to-day has been exhausted. After this they bring up the “doctor not nominated” excuse which I then have to explain to them is for a claim last year and falls within last year’s nomination. If I had made this claim on the 28th of November I wouldn’t have to deal with this. On the one occasion where I was actually able to get the call centre staff member to actually listen and understand me I was promised a call back and that didn’t happen. I asked to be called again and I was only to not be called back with the signal dropped (I told this person it would happen but it seems like it is not worth their time calling me back to finish the conversation.) and I am still waiting for that to happen. I feel like, at this point, they are trying to get me to give up so that they can keep my money.

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply26 Feb 2018, 14:44
Official

Thank you for your comment, a consultant will do some investigating and get back to you shortly.

Kind Regards
The Fedhealth Online Team