RM
Rotondwa M

1 reviews | Active since Aug 2017

13 Oct 2020, 23:37

Service is utterly unacceptable and unprofessional - 0 stars

I did a procedure with Dr EJ Moloi in June 2020. There was issues with the pre-authorisation from the medical aid as his receptionists could not get through to the medical aid, I eventually got this myself and sent through to them after they informed me of this.

After the procedure, the doctors offices sent through a claim to the medical aid that did not match the codes that were pre-authorised and the medical aid rejected the claim. 4 months later and this has not been resolved.

On 4 September I was informed by the doctors offices that the medical aid has rejected the codes that they submitted and I need to come into the office and submit the claim myself on their system using the codes that I believe are correct - as approved by the medical aid.

I went to the doctors offices on 9 October 2020 and all hell broke loose. I was given the receptionists - Ayanda computer to process the claim and I selected all the codes that had been pre-approved by the medical aid. Before the claim was submitted, I asked the doctor as to why the codes that were approved by the medical aid were not submitted, after the codes they submitted were not approved. I also asked why I was not sent the codes that were rejected by the medical aid so I could follow this up myself as they were struggling with the medical aid. On asking this, the doctor got agitated and said that I am disrespecting him and his job and what he is going to do is to change the account from a medical aid account to a private account. This make the medical bill go up from 12k to 35k. When I asked why he was doing this he said that I seemingly know better and imp**** that his office was doing me a favour by submitting the claim on my behalf. He said that I should go sort everything going forward with the medical aid.

On 12 October 2020 the doctors offices sent me a bill made out to me for 35k. I called the medical aid on 13 October 2020 and let them know about this. They informed me that they will only be able to pay bill at the medical aid rate which will be 12k only, to do this I would need to submit an invoice in my name with all authorised codes. I then called the doctor to request an amended invoice showing the authorised project codes. The doctor refuses to provide this despite me clearly stating that I need this for submission to the medical aid.

This matter is ongoing and I have not received an invoice.

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