ZERO STARS!!!!! WORST medical health scheme EVER!

ZERO STARS!!!!! Worst medical health scheme EVER! I advise you to NEVER take out FedHealth medical aid. DISGUSTING customer service! Big ******** who look for any excuse not to pay out! They will give you the RUN-AROUND and leave you with piled up medical DEBT!

I've never been hospitalized for anything since starting with FEDHEALTH in 2016. On 21st April 2022 I was admitted into the Morningside Clinic (closest to my home) for an emergency on a leaking inflamed gallbladder. This is a Prescribed Minimum Benefits (PMB) case. It has a specific code, K81.0, representing the emergency medical condition. FedHealth authorized the emergency hospital admission.

I am absolutely furious with FedHealth. Every claim put through by my service prodder, whether it’s the anesthetist, the ICU doctor, my surgeon… they find some sort of problem or issue and decline payment. I have to call, log a complaint, and get my provider to motivate the PMB and escalate the matter.

I had to log 2 calls for my hospital claim to be resolved.

Then again 3 calls for my anesthetist to be sorted out.

But I have now made ANOTHER 3 calls about my surgeon’s bill, to no avail.

1. First call because they refused to pay out, until that I got my surgeon to motivate by sending in the ultrasound and medical report. Then they declined AGAIN claiming that this was not an emergency, even though they had paid both the hospital and the anesthetist as PMB!!!! Basically, it’s a de facto admission that this is an emergency!

2. So, I called AGAIN, (27/07) explaining that if they have paid out the hospital and anesthetist as PMB’s they are admitting that this was in fact an emergency. I requested that the matter go back to review. I asked for a reference number and sent that reference number to my surgeon’s accounts office. DECLINED AGAIN. This time they claimed that my surgeon is not on their listed designated service providers! It was an emergency; I was assigned the first surgeon available in the emergency rooms. I had no choice whatsoever! And I should point out that the customer service gentleman (Katlego) was absolutely useless, had no idea how to explain the issue nor how he could assist me. He just repeating the reason for the rejected costs!

3. Today, I called for the THIRD time to follow up on my request that the surgeon’s costs be paid out. I gave the reference number to some customer service person, whose name couldn’t hear, this time the reason for declining to pay my surgeon was that the code was incorrect! The ****! When I demanded she tell me the code (Which I know to be K81.0) and which was on my surgeon’s statement and which I had checked against the 271 specific codes for PMB’s. She said I must look it up on the internet and then she disconnected my call! THIS IS ABSOLUTELY DISGUSTING BEHAVIOUR FROM CUSTOMER SERVICE STAFF. I even waited to see if she would call me back in case it was a dropped call… and 3 hours later I’m still waiting.

To make matters worse, FedHealth has charged out of my wallet money for the ICU doctor and other things that should technically be fully paid under the PMB.

Let’s not even talk about this **** of a ‘wallet’ which acts like a rip of a credit card system. So that you end up paying exorbitant amounts on your premium EVERY month. Why the hell am I paying a premium if FedHealth then charges you extras'? They are happy to debit my account monthly for years without any run-around from me, but it's okay for them to make my life a living hell and stress me out about emergency medical bills that under the RSA laws they are OBLIGATED to pay IN FULL.

I am beyond angry at the high-handed, stonewalling manner in which FedHealth has taken with me. UNTIL a FedHealth manager or someone who has the ability to resolve this matter contacts me (and I’m not interested in your social media teams standardized reply) and SORTS IT OUT TO MY SATISFACTION I intend to put a review on Hello Peter EVERY SINGLE DAY until your rating is beyond hope. I will back date the review to account for the past 20 days that I have been stonewalled.

There will come a point in the next month when I file a formal complaint with the CMS Council and if all else fails, I intend to sue FedHealth. At that point, I will recruit all other FedHealth customers who are facing similar issues to mine, and I WILL make is a class action legal case.