Refuse payment

A consultant has been in contact with me and provided feedback. The reason given why they did not pay for the PMB condition is that no authorization for the emergency visit was requested. I’ve explained to the consultant that we were under the impression that Wilgers Trauma Unit requested the authorization and we were never asked to get authorization. From there the conclusion that Wilgers Trauma Unit requested it. It is normal practice with an elective admission and procedure that the patient is responsible for requesting authorization in advance, but with an emergency it is self-explanatory that authorization is not request in advance before entering the hospital or emergency unit. During an emergency (except with a PMB condition after hours, they will request it the following day or request you) or elective admission the hospital will not admit you before they receive authorization. This is to make sure that they get paid, otherwise they will request a deposit before admitting you. Wilgers Trauma Unit did not request (because the total sum would not be so high and knew they will get their money from the patient) or forgot to do it. At no time did they request or inform the patient to request authorization at a later stage. Now Fedhealth wants to penalize the medical member with a R1000.00 for late requesting of authorization, where it is obvious that the fault lies with the service provider. As a general medical practitioner, myself, I am very disappointed in the service of Fedhealth and will find it difficult to recommend Fedhealth medical aid to others.

Fedhealth still refuse to make full payment to the trauma unit, although it is a PMB and by law they are supposed to pay it in full. As a doctor myself it is very difficult to recommend a medical aid who makes it so difficult for members.