sH
sonja H
1 reviews | Active since Feb 2014
28 Aug 2020, 10:20
GENISIS MEDICAL AID THE WORST EVER!!!!!!!@
Good day My name is Sonja Hartman and can be reaced on email *** with any legal advice I think this is the worst medical ever.I was admitted to hospital in April with severe abdominal pain.The doctors did test on me and after I was sent home the medical refused to pay the accounts.Firstly I had to pay my blood test about R3000.Now they refuse to pay the hospital stay.The hospital showed me every time they had autherised updates from Genisis.I will not stand for this as I will get legal advise !!!!!
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Genesis Medical Scheme's replyOfficial
28 Aug 2020, 15:33Dear Sonja
We have looked into your query and would like to reassure you that there is no need to obtain legal advice.
What happened with your unpaid accounts is not unique during the lockdown period. A lot of hospitals have (and still are) experienced a huge backlog in respect of their administration.
When the hospital account for your May (not April) admission was audited, the Scheme picked up that some of the billing codes were incorrect. We informed the hospital via email and copied you. We also called you the following day and explained the reason for the rejection. We further explained that the hospital account will be re-processed for payment once an updated account has been received. To date, the Scheme has not received an amended account.
As far as your blood tests are concerned - some of the tests were not paid as the type of tests done, did not clinically relate to the reason for your admission. This too, was queried with the pathology laboratory.
Genesis is not refusing to pay your claims; instead, we are waiting for feedback from the pathology lab, as well as an amended hospital account. All our claims are audited (for the protection of the Scheme, which is owned by the members) prior to payment and if provider accounts are incorrect, or we don’t have sufficient clinical information in support of paying related claims, then the process is put on hold until the necessary feedback is obtained / adjustments have been made.
The responsibility of obtaining amended accounts, or to provide additional information, always rest on the shoulders of the members of medical schemes. However, we have contacted the hospital and the pathology laboratory on your behalf today and explained the urgency of the matter. On Monday, all things equal, we are hoping to have updated feedback from both providers. We will also give you a call on Monday to let you know the outcome.
We trust that you will find this in order.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply28 Aug 2020, 15:33
Official
Dear Sonja
We have looked into your query and would like to reassure you that there is no need to obtain legal advice.
What happened with your unpaid accounts is not unique during the lockdown period. A lot of hospitals have (and still are) experienced a huge backlog in respect of their administration.
When the hospital account for your May (not April) admission was audited, the Scheme picked up that some of the billing codes were incorrect. We informed the hospital via email and copied you. We also called you the following day and explained the reason for the rejection. We further explained that the hospital account will be re-processed for payment once an updated account has been received. To date, the Scheme has not received an amended account.
As far as your blood tests are concerned - some of the tests were not paid as the type of tests done, did not clinically relate to the reason for your admission. This too, was queried with the pathology laboratory.
Genesis is not refusing to pay your claims; instead, we are waiting for feedback from the pathology lab, as well as an amended hospital account. All our claims are audited (for the protection of the Scheme, which is owned by the members) prior to payment and if provider accounts are incorrect, or we don’t have sufficient clinical information in support of paying related claims, then the process is put on hold until the necessary feedback is obtained / adjustments have been made.
The responsibility of obtaining amended accounts, or to provide additional information, always rest on the shoulders of the members of medical schemes. However, we have contacted the hospital and the pathology laboratory on your behalf today and explained the urgency of the matter. On Monday, all things equal, we are hoping to have updated feedback from both providers. We will also give you a call on Monday to let you know the outcome.
We trust that you will find this in order.
Yours sincerely
GENESIS MEDICAL SCHEME