EL
Elnie L

1 reviews | Active since Nov 2020

26 Nov 2021, 11:42

Refusing to provide a designated service provider within a reasonable distance for PMB treatment

The absolute worst thing i have ever experienced. Assisting my father with an operation he has to get. The diagnosis is a prescribed minimum benefit. He is on a network plan. The medical scheme has the right to require that he goes to a network hospital, but they also have an obligation to supply a DSP that provides the service within a reasonable distance form where he lives. He phoned every network hospital in Pretoria (he lives in Pretoria) but could not find a DSP that has the necessary equipment for the procedure. He submits an authorisation for a non-network hospital. They provide an authorisation imposing a co-payment. So we send them an email on Saturday to explain that we could find no DSP, they have an obligation to provide us with the name of a DSP that can do the op close by, or alternatively supply an authorisation for the non-DSP without co-payment (as per PMB legislation). On Monday we phone to ask that they give their attention to the email. We explain the whole story again. Phone again on Tuesday. Explain the whole story again. Phone again on Wednesday, Explain the whole story again. Thursday we get another authorisation imposing the co-payment with not so much as a word in response to the email sent and the numerous phone calls to follow up (this is rude, but unfortunately not against the law). Phone again on Thursday and Friday, both times explaining the whole story again. Finally on Friday i demand to speak to a manager. She has me hold on for 10 minutes whilst she un-successfully searches for a DSP that provides the service, offering to send me the list of DSP's, asking me to read to her their list of DSP's so that she can phone them again. Still waiting for feedback. My question is: If you are unable to provide a DSP within reasonable distance that can perform a reasonably common and simple PMB procedure, how the hell can you expect the member to find such a DSP. Fedhealth, the law requires that you make it easy for a member to get to a DSP for treatment for their PMB conditions. Why is it so difficult to get this out of you?

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply26 Nov 2021, 11:56
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