AW
AJ W

1 reviews | Active since Aug 2012

01 Sept 2016, 22:40

Co payment charged for an emergency event.

<p>I am very disgusted with Medihelp.</p> <p> </p> <p>Why am I being charged a Copayment for the following event that took place?</p> <p>In a nutshell, 18 April 2016 I was driving back home from work because I really started feeling bad.</p> <p>On my way home on the highway I started getting needles and pins in my face and my legs suddenly went numb together with my hands starting to go into clutching spasms. I managed to activate my vehicles tracking device for help. While on the phone I started getting blackouts. Miraculously I stopped at a filling station and in the meantime my vehicle tracking company dispatched an ambulance to my location.</p> <p>I was taken to hospital casualty via the ambulance not knowing which hospital (in this case it was Waterfall Netcare) My admission time on the form was 16:51 on 18 April 2016.By the time Medihelp was phoned to get Authorisation they were already closed. The following morning authorisation was granted but then I found out this specific hospital is not part of the network option of my medical aid plan. I immediately asked to be transferred to the relevant hospital which was done solid was discharged and re admitted to the correct network hospital.</p> <p>Now, according to Medihelp, in a case of an emergency you will be taken to the nearest hospital even if it is not a network hospital. Once stabilized you will be transferred and there is no Copayment of 30%</p> <p>So based on the above event, why then am I charged a copayment by the hospital which I received today. Does Medihelp think I will just use the ambulance for love and charity? Another point, YOUR AUTHORISATION DEPARTMENT WAS CLOSED!!!!!!!! Do you think I drive with the list of hospitals in my pocket????I phoned your Medihelp call center, suddenly they say I must be on the verge of losing a limb and or be in a life threatening situation. So, in my case it was not life threatening??? I must first die and rise from the dead in order for you to classify it as an emergency????</p> <p> </p> <p>EVERY MONTH I PAY MEDIHELP AND THIS IS WHAT I GET AFTER YEARS AS A CLIENT?</p> <p>This is now the second time I have an issue where Medihelp just could not be bothered!</p>

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Replies (2)
Medihelp
Medihelp's reply02 Sept 2016, 07:14
Official

Dear eaglegt01

Thank you for taking the time to bring your complaint to our attention. The contents have been noted and we are currently investigating the matter.

The complaint will be responded to by one of our consultants.

Kind regards

Medihelp Customer Care

Medihelp
Medihelp's reply12 Sept 2016, 10:50
Official

Dear eaglegt01

As per the email communication sent to you earlier, the 35% co-payment levied on the hospital account was app**** correctly.

The account was investigated as requested, but the admission diagnoses supp**** by Netcare Waterfall City Hospital does not qualify for Prescribed Minimum Benefits (PMB).

Please note as from 1 January 2013, ER24 is Medihelp’s partner in offering emergency medical transport services.

Kind regards

Medihelp Customer Care