FAILURE TO PROCESS A CLAIM

On Sunday 1 November my daughter banged her head against the edge of a swimming pool. As we were visiting relatives in Durban and could not use one of our regular doctors or hospitals, we took her to the Ethekwini Hospital for treatment. There was excessive bleeding and severe swelling and we needed to ensure that she had not indeed fractured her nose. After having paid more than R1700 in cash, the hospital submitted the doctor's bill to Liberty Medical Scheme, only for them to reject it because there were no benefits. When I explained that this was an emergency visit and that I have two emergency visits that I have not used for the current ear, Nicole Thomas wrote to let me know that I am supposed to obtain pre-authorization before I go to hospital. According to her, I suppose I should have looked into my crystal ball, saw that my child would have an accident and obtained pre-authorisation. I cannot understand how people can so blatantly fail to honour their contractual obligations.