Shocking Claims Service for member ***9

<p>As Clients of Liberty for over twenty years it is very apparent that the recent merger between Liberty Medical Scheme and Bonitas has resulted in lack of integration, poorly trained staff and shockingly bad service for its clients.</p> <p> </p> <p>The level of service and poor quality of the Hospital Select Policy product was only demosntrated to us when my mom fell and broke her wrist on the 10th July. We went immediately to casualty in Pretoria when it happened and paid for our x ray and consultation in cash.</p> <p> </p> <p>It was established that the injury was surgical and the doctor on call referred us to an orthopedic surgeon. As we do not live in Pretoria, the doctor stabilised the arm and we drove home to our resident hospital Bedford Gardens to see the Orthopedic Surgeon on call. His decision was to wait until the swelling went down and only operate on Tuesday the 12th July.</p> <p> </p> <p>I called on Monday the 11th July and obtained two pre-authorisation codes related to casualty and the hospital stay. We paid an R8500 co-pament to Bedford Gardens as this was not a designated service provider on the Hospital Select Plan, which is rediculous considering this was not an elective surgery and as a result of a casualty and other similar prices hospitals within the Life Group are covered.</p> <p> </p> <p>When all bills were sent to us we submitted them immediately to Liberty for settlment on the 23 July.</p> <p> </p> <p>It has taken over twenty calls and emails to ensure that all accounts be addressed in full. The hospital account, surgeon account and anesthetist ( all vital services pre-approved by you) had to be re-submitted more than 3 times before you finally settled these accounts through numerous interim payments.</p> <p> </p> <p>Thjis made it impossible for us to establish waht was unpaid at any time because at no point does the claims statement reflect the historical payments to give the policy holder a consolidated view.</p> <p> </p> <p>We are yet to receive a consolidated claims statement that reflects all claims paid against the total invoice from each supplier, making it impossible to see what the shortfall is.</p> <p> </p> <p>We are yet to recive a claims statement that acknowledges our co-payment of R8500. Without this, we are unable to recover this amount from our Gap Cover. This is urgent and I have requested it 6 times!</p> <p> </p> <p>After 7 weeks of chasing your claims department, we have today been notified that the Orthopedic's consutaltion in casualty at Bedford Gardens will not be covered by the policy, despite a pre-authorisation for casualty being issued under number PILB ********** 1. The doctor's codes of 0174 and 0147 are perfectly legitimate in terms of the Medical and Dental Professions Board and gazetted in September 2012, but your underwriters have failed to acknowledge this!</p> <p> </p> <p>I am well aware that the Hospital Select policy is a basic policy and that higher cover is available. However, casualty is covered and so should consultations relating to the casualty by specialists be covered!</p> <p> </p> <p>Despite having been covered by the Liberty Medical Lifestyle Policy for twenty years, the government of South Africa failed to recognise this is as a legitimate Medical aid scheme and so we were forced to pay a late joiner's fee with penalties for mom's age and migrate to Hospital Select. </p> <p> </p> <p>We now face a decision to either upgrade from Hospital Select or move to another insurer where we stand some chance of receiving decent service in the event of claim. Naturally, the odds are stacked against us, as should my mom ever experience future complications related to her borken wrist, this will be excluded form any future cover. </p> <p> </p> <p>Considering the trauma we have gone through, your staff at the call centre are rude and unqualified and have to refer every single underwriting question to another department that your clients are not able to access. Every time I call, I must speak to a different person and wait for your pathetic refernce number to be issued before you will respond to my query. For any LIberty Clients reading this, please note that a DNZ refernce is meaningless and that the 3 day turnaround time to respond to you will not be honoured.</p> <p> </p> <p>I deeply resent the pain and inconvenince that you have put my mother through while still having to pay exorbitant fees every month for very inferior cover. </p> <p> </p> <p>Please contact me urgently to discuss how you intend to repair this relationship.</p> <p> </p>