1 reviews | Active since Apr 2010
Admitted Into Hospital - Medihelp refuses to pay!
<p>On the 10 Aug 2016 my GP, very concerned, contacted a specialist at Garden City Hospital as I was suffering from extreme abdominal pain. He was concerned it might be a bleeding ulcer or something else. The specialist said I needed to be admitted immediately. I arrived at the Garden City hospital and waited for a long time to be admitted. By the time I reached a consultant in pre authorization, Medihelp offices were closed and could the hospital could not process the pre authorization. But as it was an emergency they admitted me and said they would sort out Medihelp the next day. I never heard back from Medihelp or the hospital the rest of the day. I was sent for a sonar and blood tests that night and the next morning, 11 Aug, the Specialist Surgeon was still unsure what the cause was and said a GScope needed to be done as soon as possible to determine why I was in so much pain. I went into surgery early afternoon and when I woke up I had received an SMS from Medihelp saying I had a short fall of R2650.00 I needed to pay. No explanation on why or what. The hospital never informed me of anything either. No Medihelp case manager even phoned me. How was I supposed to know this? If I knew there was a problem I could have sorted it out before I went in for the scope. But I knew nothing as I was never informed. So I started investigating and found out that Medihelp do not cover Endoscopy procedures. However without this procedure I am not sure how the specialist would have determined I have a Hiatus Hernia and Gastroesophageal reflux disease. Maybe they would have been able to just guess what was going on as my Medical Aid was unwilling to pay for the procedure? And I wonder if I had the scope and they found a bleeding ulcer and needed surgery, would Medihelp still refuse to pay? I am so shocked and disgusted by this, as I have been with Medihelp for 8 years and NEVER been admitted into hospital. I pay R3636.00 a month. More than what this shortfall costs. I would hope when I end up in hospital as an emergency, then they would look after me and pay for the treatment and procedures needed to determine why I have fallen ill. But I have been let down and I fear for the future when I am in an accident or have a serious condition that Medihelp will not pay the bills and I will be left with financial problems. I feel bul**** by a big corporation that has no regard for their clients. Maybe I should take my business and money somewhere else. Pay the bill Medihelp and stop making excuses.</p>
Dear Lanah-Lee
Thank you for taking the time to bring your complaint to our attention. The contents have been noted.
As previously communicated, our client service department is currently busy with the investigation and a consultant will contact you in this regard.
Kind regards
Medihelp Customer Care
Dear Lanah-Lee
Thank you for taking the time to bring your complaint to our attention. The contents have been noted.
As previously communicated, our client service department is currently busy with the investigation and a consultant will contact you in this regard.
Kind regards
Medihelp Customer Care
Since being admitted into hospital, phoning Medihelp and emialing, and then logging several complaints with them as no one could assist me, Medihelp has not once bothered to contact me. I hope now this will happen and Medihelp will do the right thing and pay the outstanding bill for Garden City Hospital.
Since being admitted into hospital, phoning Medihelp and emialing, and then logging several complaints with them as no one could assist me, Medihelp has not once bothered to contact me. I hope now this will happen and Medihelp will do the right thing and pay the outstanding bill for Garden City Hospital.
A very nice Medihelp consultant contacted me on the 25 Aug and told me she will be looking into this case and if the correct code was submitted then Medihelp would pay. However she told me if she didnt come right with the hospital she would contact the specialist directly. She said she would keep me updated on the progress. I have since then not heard back anything from Medihelp. No call or email. I really hope that they are working on the case and making the outstanding payment.
A very nice Medihelp consultant contacted me on the 25 Aug and told me she will be looking into this case and if the correct code was submitted then Medihelp would pay. However she told me if she didnt come right with the hospital she would contact the specialist directly. She said she would keep me updated on the progress. I have since then not heard back anything from Medihelp. No call or email. I really hope that they are working on the case and making the outstanding payment.
Dear Lanah Lee
The Medihelp consultant who is busy with your enquiry, will contact you with an update.
Kind regards
Medihelp Customer Care
Dear Lanah Lee
The Medihelp consultant who is busy with your enquiry, will contact you with an update.
Kind regards
Medihelp Customer Care
Just receieved an email from Medihelp telling me that they will not pay as the final diagnoses according to the scope report is gastro-intestinal reflux ( ICD code K219) that does not meet the criteria for PMB benefits. However I also have a hiatus hernia with the gastro-intestinal reflux. After the case manager told me she would phone me and give me an update. Still no phone call. Just as per usual a email just stating no payment.
I cannot belief that they will not pay this account ! It is a disgrace how they treat their customers. After this I am thinking of leaving Medihelp and taking my money somewhere else where the medical aid actually covers medical emergencies when in hospital. If the specialist did not perform the scope then how would he have known what was going on. Or should he have guessed and just treated me? And just because it wasn't cancer or a bleeding ulcer the medical aid now have the right not to pay for the procedure? I do not understand this? I am not at all happy with the way Medihelp has dealt with this issue and still feel when one is admitted (not willingly) as an emergency to a hospital then your medical aid should pay for the procedures and tests needed to determine why you have been admitted. This also makes me worry if I am in an accident or became very ill will Medihelp also only cover life threatening procedures/treatments and everything else they determine is not serious I will have to pay for. Why am I on a medical aid then? Very concerned and not willing to pay. I would seriously caution people when joining Medihelp as it seems they have all kinds of shortcuts and excuses not to pay for things.
Just receieved an email from Medihelp telling me that they will not pay as the final diagnoses according to the scope report is gastro-intestinal reflux ( ICD code K219) that does not meet the criteria for PMB benefits. However I also have a hiatus hernia with the gastro-intestinal reflux. After the case manager told me she would phone me and give me an update. Still no phone call. Just as per usual a email just stating no payment.
I cannot belief that they will not pay this account ! It is a disgrace how they treat their customers. After this I am thinking of leaving Medihelp and taking my money somewhere else where the medical aid actually covers medical emergencies when in hospital. If the specialist did not perform the scope then how would he have known what was going on. Or should he have guessed and just treated me? And just because it wasn't cancer or a bleeding ulcer the medical aid now have the right not to pay for the procedure? I do not understand this? I am not at all happy with the way Medihelp has dealt with this issue and still feel when one is admitted (not willingly) as an emergency to a hospital then your medical aid should pay for the procedures and tests needed to determine why you have been admitted. This also makes me worry if I am in an accident or became very ill will Medihelp also only cover life threatening procedures/treatments and everything else they determine is not serious I will have to pay for. Why am I on a medical aid then? Very concerned and not willing to pay. I would seriously caution people when joining Medihelp as it seems they have all kinds of shortcuts and excuses not to pay for things.
If I look at the average score people have given Medihelp, 77% are 2 stars. Which is actually really bad and then quiet a few 1 stars. Clearly customers are not happy with Medihelp's service and this is very concerning. Since becoming a bigger company they have become greedy and have let their customer service standards drop.
If I look at the average score people have given Medihelp, 77% are 2 stars. Which is actually really bad and then quiet a few 1 stars. Clearly customers are not happy with Medihelp's service and this is very concerning. Since becoming a bigger company they have become greedy and have let their customer service standards drop.
Dear Lanah Lee
I assure you that Medihelp is committed to rendering an effective service to all its clients and therefore appreciates it if problems are brought to our attention, as this allows the Scheme to address these problems and improve its client service or to put the matter in perspective.
Medihelp has always been proud of its good client service track record. The complaints lodged on the hellopeter.com website to which you refer in your last comment, represent only a very small portion of the total number of enquiries that we handle daily. This website is merely used to lodge complaints and is therefore not a true reflection of the type of enquiries dealt with by the Scheme regularly.
I have taken note of your frustration with Medihelp’s application of the rules, regulations and other healthcare interventions applicable to your membership. Medihelp is not unsympathetic to the needs of our individual members and we certainly do not aim to withhold benefits from members, but we must ensure the effective management of expenses and the sensible utilisation of benefits with available funds.
As explained during the telephone conversation with Mrs Likumbi on 1 September 2016, the services rendered from 10 to 12 August 2016 at Garden City Clinic as confirmed by your surgeon’s final diagnosis based on the scope report, do not qualify for Prescribed Minimum Benefits (PMB).
Medihelp is not indifferent to the needs or circumstances of its members, but our benefit allocations must at all times be made within the framework of the Rules. Section 32 of the Medical Schemes Act, 1998 stipulates that the rules of a medical scheme shall be binding on its members, officials and its Board of Trustees and that no exceptions can be made, no matter how deserving a case may be.
Kind regards
Medihelp Customer Care
Dear Lanah Lee
I assure you that Medihelp is committed to rendering an effective service to all its clients and therefore appreciates it if problems are brought to our attention, as this allows the Scheme to address these problems and improve its client service or to put the matter in perspective.
Medihelp has always been proud of its good client service track record. The complaints lodged on the hellopeter.com website to which you refer in your last comment, represent only a very small portion of the total number of enquiries that we handle daily. This website is merely used to lodge complaints and is therefore not a true reflection of the type of enquiries dealt with by the Scheme regularly.
I have taken note of your frustration with Medihelp’s application of the rules, regulations and other healthcare interventions applicable to your membership. Medihelp is not unsympathetic to the needs of our individual members and we certainly do not aim to withhold benefits from members, but we must ensure the effective management of expenses and the sensible utilisation of benefits with available funds.
As explained during the telephone conversation with Mrs Likumbi on 1 September 2016, the services rendered from 10 to 12 August 2016 at Garden City Clinic as confirmed by your surgeon’s final diagnosis based on the scope report, do not qualify for Prescribed Minimum Benefits (PMB).
Medihelp is not indifferent to the needs or circumstances of its members, but our benefit allocations must at all times be made within the framework of the Rules. Section 32 of the Medical Schemes Act, 1998 stipulates that the rules of a medical scheme shall be binding on its members, officials and its Board of Trustees and that no exceptions can be made, no matter how deserving a case may be.
Kind regards
Medihelp Customer Care
So nicely copied and pasted from all the other complaints I see. The only reason why people complain on Hello Peter so much is it is the only way to get Medihelp to respond to a query or complaint. Otherwise you can wait for weeks to get any feedback. I emailed several times and only after I posted this complaint did a Medihelp agent phone me. Almost immediately actually!
Just find it interesting that I had the exact same issue with Medihelp in 2014. Also had a scope done at Garden City Clinic in theater and also had issues with Medihelp not wanting to pay and then eventually Medihelp did pay for the procedure. So not sure why it is not covered now, after being admitted into hospital and having it done to determine what was going on and why I was in so much pain. I am sure this doesn't matter to Medihelp. I think it will be best to investigate leaving Medihelp and finding a Medical Aid that will cover me when I am submitted into hospital unplanned. Complaining however seems to not make any difference as Medihelp are committed not to pay for this procedure and would rather have preferred I continue to suffer from the pain then be properly diagnosed and treated.Without the scope I am sure the doctors could have just guessed what was happening? I am also more upset as pre authorization was submitted the afternoon I was admitted into the hospital and off course it took Medihelp forever to capture the authorization and only AFTER I had the procedure done (the next afternoon) I was notified via SMS that Medihelp will not be paying a shortfall of R2650. No explanation or anything added to the SMS. I had to contact Medihelp to find out what this amount was. If I knew this before the procedure I could have made a plan or spoken to the specialist, but NOTHING was communicated to me by either the hospital or Medihelp. I assume Medihelp just think everyone has an extra R2650 to pay for an unplanned emergency procedure. I think Medihelp lacks customer service and did not even take the time to contact me and tell me the procedure was not going to be covered and maybe I need to speak to the specialist. But none of that. Just a bill. Other Medical Aids phone and follow up on their clients when they have been in hospital or have been admitted, however Medihelp could care less. As long as you pay the high monthly membership fee.
Really not happy with the way Medihelp has dealt with this and the generic response they keep giving me.
So nicely copied and pasted from all the other complaints I see. The only reason why people complain on Hello Peter so much is it is the only way to get Medihelp to respond to a query or complaint. Otherwise you can wait for weeks to get any feedback. I emailed several times and only after I posted this complaint did a Medihelp agent phone me. Almost immediately actually!
Just find it interesting that I had the exact same issue with Medihelp in 2014. Also had a scope done at Garden City Clinic in theater and also had issues with Medihelp not wanting to pay and then eventually Medihelp did pay for the procedure. So not sure why it is not covered now, after being admitted into hospital and having it done to determine what was going on and why I was in so much pain. I am sure this doesn't matter to Medihelp. I think it will be best to investigate leaving Medihelp and finding a Medical Aid that will cover me when I am submitted into hospital unplanned. Complaining however seems to not make any difference as Medihelp are committed not to pay for this procedure and would rather have preferred I continue to suffer from the pain then be properly diagnosed and treated.Without the scope I am sure the doctors could have just guessed what was happening? I am also more upset as pre authorization was submitted the afternoon I was admitted into the hospital and off course it took Medihelp forever to capture the authorization and only AFTER I had the procedure done (the next afternoon) I was notified via SMS that Medihelp will not be paying a shortfall of R2650. No explanation or anything added to the SMS. I had to contact Medihelp to find out what this amount was. If I knew this before the procedure I could have made a plan or spoken to the specialist, but NOTHING was communicated to me by either the hospital or Medihelp. I assume Medihelp just think everyone has an extra R2650 to pay for an unplanned emergency procedure. I think Medihelp lacks customer service and did not even take the time to contact me and tell me the procedure was not going to be covered and maybe I need to speak to the specialist. But none of that. Just a bill. Other Medical Aids phone and follow up on their clients when they have been in hospital or have been admitted, however Medihelp could care less. As long as you pay the high monthly membership fee.
Really not happy with the way Medihelp has dealt with this and the generic response they keep giving me.
Still waiting for a response on my previous comment. See another case of Co-Payment issues on the recent complaints for Medihelp. One has to either be dying, have cancer or be in a life threatening situation before Medihelp pays for certain procedures. And I also see more complaints about not being able to get pre authorization for emergency admission into a hospital. Seems I am not the only member dissatisfied with the way Medihelp is treating their clients. Very concerned.
Still waiting for a response on my previous comment. See another case of Co-Payment issues on the recent complaints for Medihelp. One has to either be dying, have cancer or be in a life threatening situation before Medihelp pays for certain procedures. And I also see more complaints about not being able to get pre authorization for emergency admission into a hospital. Seems I am not the only member dissatisfied with the way Medihelp is treating their clients. Very concerned.
Dear Lanah Lee
Your statements regarding Medihelp are wrongful and Medihelp views the matter in a very serious light. Medihelp reserves the right to take further action, to the extent necessary, should the need arise. Your enquiry regarding the co-payment on endoscopic procedures will be dealt with in a separate email.
Kind regards
Medihelp Customer Care
Dear Lanah Lee
Your statements regarding Medihelp are wrongful and Medihelp views the matter in a very serious light. Medihelp reserves the right to take further action, to the extent necessary, should the need arise. Your enquiry regarding the co-payment on endoscopic procedures will be dealt with in a separate email.
Kind regards
Medihelp Customer Care
Thank you for the summary you sent me on email. I was really expecting a phone call.
I find the way you responded to my Hello Peter complaint very unprofessional as it is my right and every other person on HelloPeter,complaining about Medihelp, right to air my views and frustrations. I feel that if Medihelp dealt with these types of complains in a more efficient manner, your clients would not become so upset and frustrated. I will pay the R2650 as I am being forced to do so and just to end this ********** ordeal of back and forth complaining and getting no were. I feel you have really dealt with this situation in a very disappointing way and the interaction with your company has left me feeling threatened and worried . I am in fact still a client of your business and as with every business I have the right to complain and query your service to me. I pay a lot a month to be part of your scheme and it is your job as a business to provided a certain standard of service to your members.
Regards
Lanah-Lee van der Berg
Thank you for the summary you sent me on email. I was really expecting a phone call.
I find the way you responded to my Hello Peter complaint very unprofessional as it is my right and every other person on HelloPeter,complaining about Medihelp, right to air my views and frustrations. I feel that if Medihelp dealt with these types of complains in a more efficient manner, your clients would not become so upset and frustrated. I will pay the R2650 as I am being forced to do so and just to end this ********** ordeal of back and forth complaining and getting no were. I feel you have really dealt with this situation in a very disappointing way and the interaction with your company has left me feeling threatened and worried . I am in fact still a client of your business and as with every business I have the right to complain and query your service to me. I pay a lot a month to be part of your scheme and it is your job as a business to provided a certain standard of service to your members.
Regards
Lanah-Lee van der Berg