JS
Jacques S

1 reviews | Active since Apr 2010

22 Aug 2017, 09:08

VERY LOW SCHEME RATES

I had a severely deviated septum, causing sinus issues, which needed to be corrected. I obtained numerous quotations for the operation, and CHOSE ONE OF THE CHEAPEST OPTIONS. Authorization was obtained well in advance (authorisation number: ********** 0), however I was NOT notified that the specialist was not on the "Fedhealth network". Fedhealth then paid only R7650.45 of the R22510.50 for the surgeon, and only R1796.90 of the R6276.40 for the anaesthetist. This equates to a shortfall of R19339.55 on a R28786.90 charge! I enquired about the large gap, and Fedhealth keeps replying that because I did not utilize specialists in their network, the claim was paid at "100% of the Fedhealth Rate". I keep explaining that although I understand that part and expected a shortfall to some extent, their "100% Fedhealth rate" just seems extremely low for a Septoplasty and Functional endoscopic sinus surgery (FESS). So I pay them just over R50k per annum, yet their "100% Fedhealth rate" leaves me with a bill for R19339.55 while they pay R9447.35. I have been asking how to go about cancelling my family membership, and for the paperwork to be sent through, to no avail. Please send me the cancellation forms or advise how I should go about cancellation...

0
Replies (4)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply22 Aug 2017, 11:22
Official

Thank you for your comment, we are currently investigating and will revert shortly.

Kind Regards
The Fedhealth Online Team

JS
Jacques S's update25 Aug 2017, 11:26
Reviewer Update
Cancellation submitted, taking family elsewhere. "100% Fedhealth rate" left me with a R19339.55 shortfall on a R28786.9 charge.
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply04 Sept 2017, 12:09
Official

A consultant has been in contact with you and detailed feedback has been provided.

Kind regards

The Fedhealth Family

JS
Jacques S's update04 Sept 2017, 12:29
Reviewer Update
"detailed feedback" = same feedback from beginning, stating that claim was paid at "100% Fedhealth rate", however no feedback on the actual question, which is why the "100% Fedhealth rate" is so low for Septoplasty and sinus surgery. Cancellation effective 1 October ;-)