AVOIDANCE OF PAYING CLAIMS

<p>We as a Physiotherapy practice that deals with hundreds of claims with over 200 Medical Aids every month have hit a brick wall with HOSMED. They are by far the most unefficient Medical Aid we deal with, and with 200 odd, that is saying alot.</p> <p>Standard procedure for in hospital treatment, obtain authorisation, submit the claim via EDI with said authorisation, Medical aid accepts or requests you make certain amendments and then pays claim.</p> <p>With Hosmed, all of the above but claim is always rejected (reason 188), Phone Hosmed, hold for 30 minutes, get told their THEIR OWN auth department has not linked the claim to the auth, transfer you through to said department, said department claims otherwise, transfers you back. Get cut off. Phone again, hold for a further 30 minutes, get told the same thing. Wait 2 weeks and try again..... same same same.... and so it goes until a miracle happens and you get hold of a team leader with enough common sense to resolve the issue. This is usally 120+ days after the claim was actually submitted.</p> <p> What are we expected to do to get these claims done, we are the client, we cannot continue to be transferred backwards and forwards between PHA and Hosmed when clearly somebody is not doing their job properly. IT IS AN INTERNAL HOSMED ISSUE, NOT OUR PROBLEM, NOT THEIR PAYING MEMBERS PROBLEM, IT IS A HOSMED PROBLEM.</p> <p>The only conclusion that can be drawn is that they wish to avoid / drastically delay paying claims.</p> <p> </p> <p>The other alternative is not to treat Hosmed patients, but then of course that goes against all medical principles and ethics, or hold the HOSMED patient liable for the account since their medical aid, who they pay, does not pay out as they should!</p>