Rejected claim

I am extremely disappointed with the way KeyHealth has handled my daughter’s claim for her prescribed heel-lift shoes.

My daughter saw an orthopaedic specialist in July, who assessed her leg-length discrepancy and prescribed heel-lift shoes. The specialist submitted the required authorisation to KeyHealth.

After several weeks, the specialist’s accounts department informed me that they had been advised that the claim would be paid in the next payment run. Based on this information, I had every reason to believe that the claim had been approved and was being processed.

However, on 2 September, I suddenly received an email from KeyHealth stating that the claim had been rejected because a letter of motivation was required.

I immediately contacted KeyHealth and requested copies of the communication in which they had supposedly requested the motivational letter from either the referring doctor or myself. If the required motivation was outstanding, I would have expected KeyHealth to notify me or the doctor so that it could be provided.

Instead of providing the requested correspondence or proof that the doctor or I had been contacted, I was simply sent the same rejection letter again.

My question to KeyHealth is very simple:

**Where is the proof that the referring doctor or I were contacted and specifically requested to provide the motivational letter?**

I am not disputing that additional medical information may sometimes be required. My concern is that the claim was apparently authorised/indicated as payable, only to be rejected weeks later, and when I requested proof of the alleged communication requesting the motivation, KeyHealth could not provide it.

This has caused unnecessary stress and delays in obtaining medically prescribed footwear for my child.

I would like KeyHealth to provide:

1. The date on which the motivational letter was requested. 2. Who the request was sent to (the doctor or myself). 3. A copy of the actual correspondence/request. 4. An explanation as to why I was informed that the claim would be paid in the next payment run if the required motivation was supposedly still outstanding.