Revoking an Authorisation Number after surgery

Dear Fedhealth

*(Please see attachment with code []) - We have all the emails available upon request

My spouse went in to see Dr Teuwen on 16 August 2022 as he was in extreme agony and pain thus needed a second opinion [he required surgery before] The Dr requested an MRI. I contacted Fedhealth authorisations on 16 August 2022 and provided them with the codes for the MRI that was requested. We received an email at 20:00PM with my spouse’ details and the authorisation number in the email. (Please see attachment with code [MI***]). My spouse went for the MRI and we had no problem paying the copayment.

On Thursday 18 August 2022, my spouse received the news that an urgent surgery is required and needed to be admitted on Saturday 20 August 2022. Again I phoned Fedhealth on 18 August 2022 and provided them with all the procedure codes. They requested documents which I’ve send through on the same day. I received the query number 180822Q7NRZM for the documents send successfully on 18 August 2022 at 12:19PM. (Please see attachment with code [MI***]). I phoned 3 times during the course of the 18th to find out what the status of the request was as we needed an answer urgently. The response I received was that it is with the medical advisor and they have escalated it.

My spouse finally received the email containing the authorization number: ***9 at 17:58PM on 18 August 2022. (Please see attachment with code [MI***]). The email had the exact same wording as the authorization email for the MRI containing the authorization number. We provided this authorization number to the hospital as well as the surgeon and the surgery took place on Saturday 20 August 2022.

During this period, myself as the main member have not received any communication or feedback from Fedhealth regarding this operation. All correspondence went to my spouse.

On Wednesday 24 August 2022, I started receiving all the claims being rejected. I contacted authorisations to understand why this is happening. Only to find out the authorization was still pending. We had numerous phone calls between 25th and 26th August 2022 where I needed to understand how you can provide us with an authorization number while it’s still being processed. Where have you ever heard of a pending authorisation number?

When my spouse had access to his emails again he noticed an email received on Monday 22 August 2022 from Fedhealth with the authorisation number revoked. (Please see attachment with code [MI***]). How can you generate an authorisation number and then revoke it after the surgery?

I have logged a complaint and requested for the recordings for 18 August as well as 26 August 2022 as the responses below that I have received telephonically is *********.

“Your system is faulty and sometimes generate authorisations numbers when it shouldn’t” “The authorisation number is because my spouse got admitted for medical care and not spinal surgery” “I should never have received an authorisation number. How did I get that?”

Up to today I have not received any communication or feedback from Fedhealth regarding this matter nor the complaint I logged.

How can you treat your clients like this? How can you expect your clients to pay a massive bill due to your system being at fault? How can you just ignore your client requests by not providing any feedback or communication. My spouse is still in extreme agony and pain and now must worry about a bill that’s over R300 000. If the initial email that was send on the 18th August did NOT have an authorisation number, he would never have proceeded with the surgery.

We pay our monthly contribution with no questions asked. Yet, when we lodge complaints we need to fight for answers.

Query Numbers received after submitting the dispute: 290822Q82V64 290822Q82V4X 290822Q82V5V

Is this the behaviour we will be receiving from Fedhealth. Just ignore and not take any responsibility regarding their system failure and leave it to the client to settle a medical account that’s over R300 000.