Chronic benefits paid from savings and treatment plans without flexibility

<p>Hi,</p> <p> </p> <p>I requested the procedure to follow for chronic BENEFITS (which includes treatment) to be approved for 2016, in November 2015. I was advised that there's nothing I need to do, as my medication is continuous.</p> <p> </p> <p>I logged my first chronic benefit claim in January 2016 and didn't pay attention as to where the funds would be paid from, as I have never had any problem with this before.</p> <p> </p> <p>I then logged the second chronic benefit for the particular condition, in June 2016. When I received the claim acknowledgement, I realised that it was scheduled to be paid from the savings benefit, which was by now depleted. I then realised the first claim was also paid from the savings.</p> <p> </p> <p>I queried this on 8 June with reference ********** 4 and was advised feedback will follow. I then phoned again and got another reference, ********** 7, whereupon I was advised that, despite the payment going off the Savings, the doctor's rooms used the incorrect treatment code. I then received a new statement from the doctor and sent it through to Claims Department, with reference to a lady by the name Ifsaan, who helped on the last reference call and advised she will consult with Claims.</p> <p> </p> <p>I have now received a claim acknowledgement and statement that both state the claim has been processed twice and will not be paid. Now these claims should both be paid from the chronic benefit, as it has always been and as I was advised it would be fine!!! And Ifsaan was the only one who returned my call once, but I never heard from anyone again after that!</p> <p> </p> <p>I also logged a request for a quotation on items I need to get for another chronic condition, for which I have a quotation from the specialist as well. This was rejected as it is not part of my treatment plan. I forwarded the mail back to Enquiries to explain that the need for this has developed because of one of my chronic conditions and isn't part of the standard treatment plan. This was DCZ# ********** and it was on June 3; I STILL haven't had a reply!</p> <p> </p> <p>I'm very very upset and unhappy and feel helpless. I have 3 chronic conditions, of which one isn't even approved as a chronic condition (and queries to have it investigated were also not attended to). That's really a lot to deal with!!!</p> <p> </p> <p>Regards,</p> <p>Sonette</p>