NZ
Nompumelelo Z

1 reviews | Active since Aug 2011

15 Aug 2022, 14:55

UNAPPROVED MEDICAL AID CLAIM

I had a medical emergency 19th June 2022 and received amazing assistance from doctors at Wilgeheuwel hospital and was free to go home but was told i needed to go back on the 20th June (which I did). I was prescribed over the counter medication /injection that needed to be ten urgently and when attempted to get the medication it was rejected and said "not covered by scheme" . Not understanding this by the way i called and was told i need to get motivation letter as to reason i need the meds and submit before medical aid can approve . I did this and submitted to fed health accordingly. Next day went to see a specialist for more check ups ... He then asked about the prescription and i advised him i was awaiting medical aid to approve and he said the meds are critical and i need to take them asap which i then paid out of pocket and it was now also double dosage that was required equating to R2K . I followed up this claim after a week and was advised that it was escalated and would take 15 days for approval and reimbur*****t if approved . Its been almost 2 months and still get the same feedback every time i call medical aid for feedback . Had i not paid for the medication at the time , i wouldve put my life in danger and for a medical aid to be looking into authorization if medical aid required for my condition is really ridiculous . It is not a chronic disease therefore not part of listed CDL but what is the reason for the medication to not be approved especially if i have funds in y wallet for over the counter . To say the service is poor is putting it mildly but i also feel ********** by Fedhealth especially in the economic times we are in . I pay for medical aid monthly and i am NOT prone to ongoing health issues but to have to wait for feedback for this long and a resolution from such a big medical scheme is appalling.

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Replies (1)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply15 Aug 2022, 15:41
Official
Dear Member, 
 
Thank you so much for your message, we are sorry you’re having such a bad experience, please bear with us while we do some investigating.  One of our consultants will be in touch with you as soon as we have a result. 
 
Best Wishes
Fedhealth