service delivery

I Selected my option and benefit very carefully as I wanted to ensure I chose correctly and was covered.

I enquired at the walk in Centre regarding assistance on a query.

The network hospital (Greencare’s) listed on my medical did not have a gynecologist that does deliveries and requested assistance in this regard. A motivation was sent and I was informed that any co-payments will be waived if I give birth at a non-network hospital (St Georges).

Due to me waiting 3weeks for feedback in the interim I enquired by all of the gynecologist's available (non-network) if they do deliveries & can assist. There unfortunately is only two doctors available that could possibly assist (non-network).

I thus informed the medical aid at the walk in Centre and enquired if they would rather waive any co-payments If I go to a network hospital and get assisted by a non-network gynecologist instead of going to a non-network hospital can be assisted by a non-network gynecologist there.

This however has been decline, due to incorrect info passed on my first request.

I did not state that the network hospital do not do deliveries but informed the consultant at the walk in centre that the network hospital does not have any network specialists that is doing deliveries therefore the hospital is currently looking at closing the maternity unit and I do not have GAP cover. As this was not needed.

With regards to the above I do not have any other option but to go with a non-network doctor as there is only two doctors available at the network hospital that can assist.

So kindly advise why it is the clients responsibility to be liable for any co-payments when none of the network gynecologist are doing deliveries but only consultations.

Kindly advise where I can escalate this matter further as it is a benefit provided on my medical aid yet I cannot utilize this benefit due to none of your network doctors doing deliveries at the network hospital.

Why should I have GAP cover to cover costs that should've been covered by my medical aid plan?

How is this a fair service delivery to me as a client, advertising a service that cannot be utilized because the network providers don't provide the service. I have posed the above to Fedhealth on 11 February 2020 in response to their decline to cover the costs of the co-payments for a non-network and to date I have not received a single response, only to be informed that my query has been closed on ref: 310120QVYYL3

regards Dissapointed client