1 reviews | Active since Dec 2011
Billing disputes
I want to log a complaint against Genesis medical aid. My daughter was booked for check up on the 13-05-19 by Dr Rowan Nichol Inc, she has been consulting to Dr Rowan Nichol Inc since she has been diagnosed with chronic Genesis reject to pay my daughter’s consultation fee R 1 202.07 and only pay R373.00 which they are saying that is from chronic scheme. I was told by consultant by Janine Swanepoel that Dr Rowan Nichol Inc is expensive that is the reason why they cannot pay. However the previous consultation fee was paid in full. I still have Available Savings: R14,187.58. I spoke to Corne Grobler who then confirmed that they won’t pay consultation and is their law. Which they never advised me about, but previous consultation fee paid in full without telling me this law that they talking about it now. I want Genesis to pay the balance left using my savings that is available as they did it before. Membership Number – ********** 7
Thank you for your enquiry.
The benefit for out-of-hospital consultations with regards to your daughter’s registered chronic condition is covered at 100% of the Medical Aid Rate (refer Appendix 1 of the Scheme Rules).
Dr Nichol unfortunately charged more than the Medical Aid Rate for your daughter’s recent consultation. If your daughter’s consultation was not relating to a registered chronic condition, then there would have been no problem for the Scheme to cover the shortfall from your available savings benefit. In this particular instance, however, it cannot be done, as the Regulations to the Medical Schemes Act specifically determine that a medical scheme may not use a member’s medical savings account to pay for any shortfalls in connection with a registered chronic condition(s).
We trust that you will find this in order.
Yours sincerely
GENESIS MEDICAL SCHEME
Thank you for your enquiry.
The benefit for out-of-hospital consultations with regards to your daughter’s registered chronic condition is covered at 100% of the Medical Aid Rate (refer Appendix 1 of the Scheme Rules).
Dr Nichol unfortunately charged more than the Medical Aid Rate for your daughter’s recent consultation. If your daughter’s consultation was not relating to a registered chronic condition, then there would have been no problem for the Scheme to cover the shortfall from your available savings benefit. In this particular instance, however, it cannot be done, as the Regulations to the Medical Schemes Act specifically determine that a medical scheme may not use a member’s medical savings account to pay for any shortfalls in connection with a registered chronic condition(s).
We trust that you will find this in order.
Yours sincerely
GENESIS MEDICAL SCHEME