PATIENT ******ION

Hi Good day

This complaint is in regards to an incident occurred to myself on 03/03/2017.

I, Mrs Fathima Khan(ID no. ********** 174088) is on the Discovery Medical Aid(card number: ********** 22)

I experienced a trauma incident on 03/03/2017 and had to have an ambulance to my assistance whereby the paramedics had to stabilize me prior to proceeding to the Mediclinic Hospital in Pietermaritzburg. Upon arrival I was rushed into the hospital and had a doctor admit me. I was then admitted and in hospital. The entire incident was a trauma incident throughout and not forgetting that I am a cardiac patient so my incident was taken into serious account.

Ever since I was discharged I have been getting numerous telephone calls and sms messages from Lancet Laboratories insisting that I was not admitted in hospital and there is an outstanding amount to settle. they have been really harassing me with sms and phone calls so I have asked my son to assist me on this matter.

My son(Shabeer) had carried out an investigation and tracked back as to what went wrong... So he called Lancet and spoke to Prashika on 23/10/2017and she advised him that according to their system it shows that there were "No Benefits". We understand that there would be two reasons to justify the explanation of "no benefits" in relation to this case, first reason would be no benefits as I do not have a savings benefit but this will only apply if I was not admitted, second reason would be a claim submitted incorrectly by Lancet exposing incompetency within the admin team with the initial claim as well as the follow up with their statements and rectifying the problem, correcting the claim and resubmitting the claim(reconciling) which i am certain that those are the responsibilities and duties of the administrative team of Lancet and should not involve the patient in any way. Shabeer called Lancet again and this time spoke to a person by the name of Dane on 23/10/2017 as we wanted to know the practice number used to submit the claim, according to Dane the practice number used is ********** (J. Tudor). We then called the medical aid to find out the reason the claim was not paid, we spoke to a person by the name of Denver(ref: ********** 152) who advised us that the claim submitted was from a practice number who is not allowed or is not suppose to request for bloods(Prac no. ********** ) which is the hospitals practice number and not a referring doctor, he also forwarded me a copy of the claim rejection with the reason code and he also advised us that if Lancet adjusts the claim and submit it correctly then the payment will go through. We called Lancet again and advised them that they have incorrectly submitted the claim by using a wrong practice number and that is the reason the medical aid have rejected the claim and we even explained to them to correct the mistake and resubmit the claim whereby they have not and still insists that there is no funds. We have also requested my doctor to do a letter of motivation to advise all concerning parties with confirmation of my hospital admission.

The most recent interaction was my son calling Lancet on the 15/11/2017 and spoke to a Carmen and explained to her what had gone wrong and she acknowledged that the practice number used to submit the claim was incorrect and we requested for the rejection statement that they received from the medical aid, she then refused and said that she cannot email those documents!? Why not? She also then said that they cant do anything now about it because the claim was done a long time ago! So in other words if the admin team on Lancet is malfunctioning and *********** in what they tasked to do then thinks its okay to just bully and ****** a patient? even harassing me all the time and recently sent me a message that they applying for judgement on my Lancet account with Ref no. Y ********** to the ITCBA

I do not understand why is it that I am liable for payment if the claim was not submitted correctly by Lancet. That is not fair I would think. I also cannot read my own bloods as i am not a doctor and I strongly feel that there is a breakdown in communication between the admitting Doctor and Lancet as the doctor requests for bloods, not the patient!!! And gathering from this incident what I find scary is how can lancet submit my personal blood results to a hospital practice number(which includes multiple staff) when only a doctor(from a doctors practice number)supposed to read my results at the strictest of confidence??

Kindly contact my son Shabeer on ********** 933(email: ********** in regards to any feedback

Refer to all supporting documents attached

Regards,

F. Khan