TL
Tommy L

1 reviews | Active since Mar 2009

24 Jul 2019, 17:58

Why is claim not paid in full??

Auth Number: NEO***A

I was at my GP Dr TP Taute (Practice Number ***) on 1 July 2019. According to the claims statement I received only tariff code 0191 was paid on 15 July 2019. On the claim that the GP submitted for service date 1 July 2019 there was 2 tariff codes that was rejected 1232 and 1186.

I lodged a query on why the above 2 codes was not paid and Joyce Zakwe then loaded the above authorization so that the account that the GP submitted for payment for service date 01 July 2019 could be resubmitted for payment in full with the 2 tariff codes 1232 and 1186 as only part of the account was paid on 15 July 2019

But today I received an update on above authorization and I saw that Essence Pololo loaded a note that tariff code 1186 was not approved for payment because I am not registered for J44 and J45.

Can someone just phone me and explain to me in simple terms why tariff code 1186 will not be paid.

Will tariff code 1232 be paid or not?

PLEASE JUST EXPLAIN WHAT ALL THE CODES MEAN??

Thank you

0
Replies (2)
Health Squared Medical Scheme
Health Squared Medical Scheme's reply25 Jul 2019, 12:56
Official
We acknowledge receipt of your concerns and thank you for bringing them to our attention. HEALTH SQUARED 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,
 
 The HEALTH SQUARED team
Health Squared Medical Scheme
Health Squared Medical Scheme's reply29 Jul 2019, 09:03
Official
Thanks for taking the time to chat to your dedicated consultant.  We are pleased we could resolve your query.  Please feel free to contact us at any time should you require assistance.

Yours in health

The HEALTH SQUARED team