Scheme Hides behind clever rules

<p>I took my son for emergency treatment for a broken arm and the scheme fails to pay citing lack of authorization.</p> <p>I have called the hospital and the hospital indicated that they don’t request for authorization for outpatient services.</p> <p>Fedhealth as per the rules will pay out of risk for emergency treatment like the case with my son but with authorization. So it seems to be that this is a very convenient rule to Fedhealth because most members will be busy seeking treatment and since hospitals don’t request for authorization , the member “forget” to request for authorization by himself and by the time the treatment is done the 48hours deadline given by Fedhealth for such claims will have expired.</p> <p> </p> <p>This rule is designed as a very clever way not to pay “outpatient” emergency claims while at same time holding the claim below. Its seems it easier for members to “request” for admission so that “authorization” is done but this costs the scheme more and of course members premium will increase in the next year to compensate for these increases.</p> <p> </p> <p>“One of Fedhealth's Unique benefits include trauma treatment at a casuality ward, whether admitted to hospital or not, emergency treatment like stiches, is always paid from Risk and never from Savings (where applicable). Co-payments apply to certian options. The above is subject to authorisation.”</p> <p> </p> <p>This statement only applies to members who carry the rule book with them and most probably will work in an ideal world. For the common like me ,it’s best to know and prepare that Fedhealth will not pay for any claims where a member is not admitted.</p>