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samantha S

1 reviews | Active since Sept 2013

02 Nov 2015, 15:53

Incorrect co-payment amount given - Member to fix

I was given a pre-authorisation number for a non contrast CT scan. I was told that i would need to co-pay R1500. On the date of treat (29 October) i made my payment of R1500 to Sandton radiology. When checking my member dashboard i noticed that the medical aid had paid R200 short. I was now liable for a payment of R1700 and not R1500 as initially provided to me. <br> I have spent alot of time on the phone today trying to get to the bottom of this. <br> Firstly they say its fixed then transfer you to client services who are rude and extremely unhelpful and they say its not changed and that i do owe R1700. Pre-auth called me back to say they have made an error and i do owe R1700. i cannot understand how this is my problem. Surely Resolution Health should be rectifying this especially when i have over R8000 in benefits. Surely to take R200 out of my benefits would not kill them when we already pay an exorbitant amount on contribution fees. We are not informed on any of the marketing material of what our co-payment should be and therefore rely on pre-auth to give us the correct amount. The fact that the memeber already has to pay more than the medical aid for the procedure is ridiculous.

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Replies (1)
Health Squared Medical Scheme
Health Squared Medical Scheme's reply02 Nov 2015, 16:35
Official
Hello samannsmit,

We acknowledge receipt of your concerns and thank you for bringing them to our attention. Resolution Health is committed to providing an unsurpassed level of service excellence to our valued members and would like to extend our sincere apologies if you feel that we have fallen short of this promise. We are assigning a dedicated consultant to your query and he/she will be in touch soonest to discuss your concern in further detail.

Please rest assured that your query will be dealt with as a matter of urgency and that we are fully committed to resolving this as soon as possible.

Yours in health and wellness,

The Resolution Health team.