Shocking Service from Fedhealth

My mom and dad are in their 80's. They pay Fedhealth R6800/month for their medical aid. They have certain chronic benefits. Each year this enables my mom to visit a specialist and to have parts of the bill covered. This year, because it was a different specialist, they are saying she is not covered. This is ridiculous, shocking and just a bunch of red tape. They make things so confusing that old people make mistakes and don't get the cover due to them. My mom has been having these specialist visits for years.

(Solile – Call reference 131118Q3JZYD ) - this was the person spoken to.

This is reasoning they give:

Please refer to below email correspondence. I was in contact with Fedhealth and unfortunately Dr Roux cannot be linked to your mom’s care / treatment plan this time of the year. The treatment plan is only created for a GP and not a specialist like Dr Roux which also explains why the codes was not corresponding to the codes that Dr Roux had used. The consultant explained, that your mom’s GP should do a clinical motivation at the beginning of every year with regards to a Specialist visit once a year and motivate to have a Specialist added to the Care/Treatment plan. The Care/Treatment plan is sent to the member at the beginning of every year where the member then must ask their GP to fill in all the details and email it to Fedhealth (email: ********** The relevant department at Fedhealth will then review the Care/Treatment plan accordingly and note the nominated GP and Specialist according to your mom’s GP’s motivation. Therefore unfortunately with regards to the above, Fedhealth will not be able to settle the account for Dr Roux and the account will have to be paid by your mom.