AWFUL CUSTOMER SERVICE WHILE PAYING MEMBER IS SERIOUSLY ILL

KERRY DE SOUSA **********

Hi All,

I am Nicky, Kerry’s daughter and between Kim and I we are beyond frustrated, angry, disgusted and of course extremely worried about my mother who is not in a stable condition.

As explained my mother was sent to Arwyp (her nearest hospital) who then confirmed she had dangerously low sodium and potassium levels, and extremely high blood sugar (diabetic level of 12.2) both of which were not pre existing conditions. She was also dehydrated and had low blood pressure due to the dehydration. Again, this is not a pre existing condition. The only pre existing condition which was disclosed to Medihelp was high blood pressure for which she is on medication for. She was NOT admitted for her blood pressure hence why Arwyp advised we admit her as we confirmed her high blood pressure was her only pre existing condition which would not be covered by Medihelp until September 2018. As Medihelp is closed on Sunday they admitted her and on Monday morning we started the process of getting pre authorisation. When I spoke to Medihelp, they advised that she was not at a preferred hospital and that if she was stable enough to move that we should move her to the Linmed and would be fully covered excluding anything for high blood pressure. Kim then took her to the Linmed who tried to get preauthorisation from Medihelp and still no luck so Kim was forced to take her home. The next day they were back at the Linmed and again her new doctor wanted to admit her as she was not stable and needed further treatment and tests. Still Medihelp would not give authorisation for this as they then said they needed to confirm with her GP that is was not a pre existing condition that she was being admitted for. Hypokalemia was the condition code given by the Linmed, which has nothing to do with her blood pressure. When speaking to Medihelp, they said they would not just pick up the phone and call her GP so I did that myself and got a letter sent to them from Dr Marais who confirmed that this was not a pre existing condition. Due to no authorisation from Medihelp we were forced to allow her to be transferred to Thambo memorial hospital where she sat in her own urine for a number of hours because they would not help her to the bathroom. She was in hell and even more dehydrated by the morning so we had no choice but to take her out of that hospital.

I have spent hours phoning Medihelp from England over the last 5 days trying to sort this out and speed up the process but they still won’t give a time frame for investigation. They say between 2 and 14 days which is unacceptable when a member is in a serious and unstable condition. It has taken hours of calls and hundreds of pounds to establish that this investigation is going at a snails pace and that they have already established that she is not being admitted to the Linmed for a pre existing condition. They claim they are trying to speak to a dr ***ard and Dr Wolmerans who treated her at Arwyp on Sunday and Monday yet that is the first time they have treated her, they have no history with her and are not able to confirm pre existing conditions, so why are they even part of this investigation? I have called both doctors myself and they will confirm they have no history of treating my mother. I also know that Dr Wolmerans is not available until Monday which means Medihelp is not going to do anything until then. In the meantime my mother is sitting in the same condition with no medical care after both hospitals did not medically discharge her and both agreed she needed to be in hospital as a matter or urgency.

I am appalled by the way Medihelp has treated my mother who is a paying member and by the way they have handled this case. Their processes and procedures are disgraceful and have no order of priority or urgency. She is not being admitted for a broken toe but a serious medical condition which is causing her to be partially immobile, weak and unstable. Her current doctor at the Linmed can confirm this as well as previous doctors at Arwyp. I also cannot understand why Medihelp ask members to disclose pre existing conditions and then prioritise their own personal investigation to double check on their members prior to giving pre authorisation. Why is this not done after authorisation has been given in order to prioritise the members health instead of Medihelp’s pocket? By all means, if upon their ‘14 day investigation ‘ they discover there were further pre existing conditions that were not disclosed on application then decline the claim but in the mean time their processes and procedures are putting their members lives at risk! Members pay every month because they cannot afford to outlay R45 000 just to be admitted should their health become a problem, so why would they think it would be possible in order to do this while they take their sweet time doing their own investigation?

Medihelp refuse to put me through to anyone higher than the supervisor I spoke to once and now refuses to speak to me, (Ardi is her name) Each time I call to chase for this pre authorisation number I am on the phone for between 30-40 mins and always with a different operator who speaks to Ardi and relays the same message that the investigation is on going and will not give a time frame. Medihelp’s treatment to their member in this case has been disgraceful.

To be very clear, my mother is in a serious condition and needs urgent treatment and Medihelp have forced us to put her life at risk because our only options are to keep her out of a hospital or leave her to deteriorate at a hospital that left her to sit in her own urine for hours, which is inhuman and not something a paying member should be forced to do due to warped procedures which clearly need addressing!

I want someone senior at Medihelp to address this and call or respond to me today! If this does not get addressed today, we will go to anyone who will listen because if my mother dies while Medihelp prioritise their back pockets, this case will be a lot more than an investigation into a pre existing condition!

I await your urgent response today!!!!!

My email is: ********** Contact number: +44 (0) ********** 264 (UK based)

Nicky De Sousa