DR
Daniela R

1 reviews | Active since May 2011

30 Nov 2017, 09:32

Ridiculous capturing of in-hospital claims

I had an emergency c-section on 23rd Oct 2017. My hospital authorisations as well as Dr authorisations were obtained at least 2 months ahead of the actual due date. What has ensued is all my claims which should have been captured under in-hospital have been taken from my savings. When I originally called them to find out why this was happening, I was told that I was "supposed" to get separate authorisation numbers for each and every service provider. Nobody informed me if this when I called for the original authorisation number for the birth of my son so I was none the wiser. Besides the none the wiser point, it was an EMERGENCY c-section... there was no time to call the medical aid to ensure cover!

I am a new mom, this is my first child...how was I supposed to know separate authorisation numbers were the right way to go. I was then informed that I am able to get post-authorisation on all servoce providers but that I had 21 days after the fact to do so. Needless to say that my original call went through to Fedhealth AFTER 21 days as that is when I first noticed something was amiss with all my claims being processed as I noted discrepancies on the email advisories coming through.

I have called countless times, received numerous reference numbers but am still being given the run around! Claims department is apparently snowed under! I called yesterday to follow up as to what was happening with my claims and again have been given the run around and more days are needed for their escalation/accounts department to recapture all my claims, refund my savings and place all claims under in-hospital. All this while I am being threatened by the providers of a possible handover for failure to pay my accounts!

My reality: Time that I should be spending bonding with my child is time I am spending keeping the wolves (service providers) at bay all the while calling the medical aid every second day to ensure that the accounts are being processed and that the capturers of such accounts actually know what they are doing this time round!

I am exhausted by this whole process and just need a resolution now. I need the service providers paid so that I can start the gap cover paperwork for shortfalls my medical aid will no doubt have! This will take more time away from me when I eventually get to that point.

Can someone with authority please take a look at this problem and assist with a resolution ASAP?!

0
Replies (2)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply01 Dec 2017, 12:04
Official

Thank you so much, we will investigate and revert shortly.

Kind Regards
The Fedhealth Online Team

DR
Daniela R's update04 Dec 2017, 07:29
Reviewer Update
Hi there. I still haven't received a response to my queries. Tomorrow marks my 6 weeks Gynae check up and payment was supposed to be made to my Gynae before this appointment. I don't have that kind of money just lying around! This is the status the least, very embarrassing! And Fedhealth are yet to comment, call and rectify my account! Kindly urgently advise!