IM
Ilze M

1 reviews | Active since Oct 2010

17 Mar 2015, 11:40

Non Payment of claims

Last year May our dentist phoned Resolution health (Resomed) to find out whether I had any dental benefit, and were given a consultation code with the call reference. Resomed then went ahead and decline the claim more than 4 months after consultation date, stating that the wrong code was used. I got involved a few months ago, and at first Resomed claimed that the wrong code was used (and remember, this code was initially supp**** by Resomed!). I got the dentist to amend the code, as per the request of Resomed. Suddenly the reason for non-payment is the fact that I did not follow up timeously! This is in short what happened over several months of very frustrating calls/emails with Resomed call centre staff. Resomed staff is VERY insistent bordering on rude, that I HAVE to follow them up to pay claims, otherwise no claims will be paid. They cannot provide me with the rules of the scheme confirming this, as this is merely Resomed's protocol.<br> <br> The amount involved is small, but for me this has become a matter of principle. How can Resolution health expect me to remind them to do their job? This is utter nonsense.<br>

0
Replies (1)
Health Squared Medical Scheme
Health Squared Medical Scheme's reply18 Mar 2015, 08:25
Official
Hello IlzeM,

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.