AS
Andre S

1 reviews | Active since Jan 2011

16 Sept 2019, 13:18

Tells Radiology you dont have benifits, but you do?????

On the 14th of Sept, i fell and hit my head around 10pm, i went to Arwyp and they did a CT scan, around midnight the Dr came to me and told me i had a mild concussion and he would like to admit me for observation till the morning as i was vomiting and had a stiff neck. So i was admitted. When the x ray dept called Fedhealth for auth, they were advised that i don't have any benefits for Specialized scans.... On the brochure, under in hospital benefits under radiology under Specialized Radiology it show the following "R13 400 per beneficiary, subject to an overall limit of R27 100 per family per year" So when i called call center i kept on countering the really poor responses on why Fedhealth does not want to pay this account. The last response was "your scan was on the 14th, but you were only admitted on the 15th so its a day after the scan was done" DO YOU NOT TAKE INTO CONSIDERATION THIS ALL HAPPEND BETWEEN 11PM AND 1AM? If this is not resolved I will hand this over to the ombudsman man, This is really shocking service.

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Replies (3)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply16 Sept 2019, 13:46
Official
Thank you so much for your review we will be in touch shortly.

Kind Regards
The Fedhealth Online Team

Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply16 Sept 2019, 14:51
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards 
The Fedhealth Family

AS
Andre S's update23 Jan 2020, 09:12
Reviewer Update
yes, after everything and this whole emotional ordeal this was sorted out and paid as per your policy. I still dont understand why you keep on rejecting claims that is with in your guidelines. How many members do you do this too?