JR
Johan R

1 reviews | Active since Oct 2019

28 Jul 2020, 14:26

Worst medical aid ever!!!!!!

i Was involved in a Motor Vehicle accident on 19 June 2020. My was taken by Ambulance to the Closest Hospital (Unitas Hospital that is a network hospital) to their casualties ward (Dr Gouws Serfontein which is not a network doctor). My Exrays was done by DR Burger (Which is a network docctor). I phoned the emergency line for Fedhealth and was on hold for more than 10 minutes, i ended the call and got into the ambulance that was on the scene. When i was in the emergency room i phoned the medical aid and they advised that i do not need authorization only when admitted to hospital. When starting the claims process they had an issue saying that i should have contacted them within 3 days after my accident to request authorization for my admission to Casualties. Claim 1. DR Gouws charged R1194.50, my medical aid is only paying for R287.10. Claiming that this is a non Network doctor, claim was reduced and payed at Scheme rate (This doctor is listed as a GP and not a casualties ward). After the Doctor wrote a motivation to state that it was an Emergency they still declined the full amount and closed my Case after fighting for more than a month. 2. DR Burger. Amount claimed for Exrays was R796.78. Medical aid only paid R511.48. The remainder R285.30 was for an emergency call out fee. (Because my accident happend after 5PM. Fedhealth advised that they will not pay that part as its not part of the codes they pay. I do not earn a lot of money, but i take a little every month and pay to have medical aid. I Pay Around R1000 per month for medical aid with them. 14 Months I have paid the that is a Total of R14000 i have paid for Medical aid, but they do not want to pay R1192.70 (Which is the remaining amount of claims rejected by Fedhealth) that is not even mentioning the medication i had to take after i was discharged.

Plainly - when you have medical Aid with Fedhealth you should know before hand that you are going to be in a accident and ensure it happens before 5.

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Replies (4)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply28 Jul 2020, 15:44
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 reply29 Jul 2020, 10:40
Official
Dear Fedhealth Member,

Kindly note, the social media team is currently trying to reach you.
Regards,


 


Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply31 Jul 2020, 15:22
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards 
The Fedhealth Family

JR
Johan R's update25 Aug 2020, 10:35
Reviewer Update
Today its 25 August, Still busy with this ****py medical aid.
Its been a process for the last 2 months of fighting. Feedback was provided stating that the incorrect ICD 10 code was used by the doctor, medical aid will make contact with the doctor to request the correct code. I was then told by Kgomotso that they received the info and claim will be resubmitted. on 31 July, Gugu came back stating that the DR never provided them with this code only a radiology report. I then made contact with the DR and requested the correct code, this was sent to medical aid and submitted for reprocessing.
Today 25 AUG (after i phoned in again, no feedback from medical aid side) i was told that there was no change, they will still not pay the claim because of the tariff code that was used.
I am sick and tired of this ****ty medical aid and all their excuses when i comes to payment. I have in the meanwhile cancelled my medial aid.