PB
Pieter B
1 reviews | Active since Oct 2016
20 Oct 2016, 14:46
**************** by Medihelp
<p>Still complaining about the fact that there will be no payment on my behalf for blood tests that were done. I was unaware of the fact that being sent by a specialist for blood tests still requires me to give you a phone call to give me permission to have the blood tests done. I told the lady who phoned me, "were you going to say no if i had phoned and asked for permission to have blood tests done", and i'm pretty sure the answer would have been yes, it is fine. So just because i didn't call for permission after being referred by a specialist (who i paid for out of my own pocket), i have to pay R1328.60 for blood tests. Just because i am wrong according to your protocol (that is probably in the fineprint), does not mean that I am wrong. I was referred for blood tests through a specialist, Dr. Basil Levetan, how much more proof do you need that I am not robbing medihelp. It is **************** and you are trying to get away with it based on a technicality.</p>
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Medihelp's replyOfficial
20 Oct 2016, 15:31Dear PieterBuckle
Thank you for taking the time to bring your complaint to our attention. Medihelp puts a high premium on effective communication with all its clients and appreciates any feedback that we receive in this regard.
I have taken note of your dissatisfaction with the application of rules and protocols on the Necesse benefit option. This benefit option is a low-cost network option in terms of which service providers are contracted by a network to render mostly primary healthcare and medicine lists (formularies), treatment protocols and pre-authorisation or registration processes apply to most services.
Medihelp offers different benefit options that members can choose from, each offering unique benefits and priced and structured accordingly. It is imperative that members must fami****ise themselves with the benefit composition of their chosen benefit options and the general rules and protocols on those options.
Your complaint has been forwarded to the relevant department for investigation and will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
Medihelp's reply20 Oct 2016, 15:31
Official
Dear PieterBuckle
Thank you for taking the time to bring your complaint to our attention. Medihelp puts a high premium on effective communication with all its clients and appreciates any feedback that we receive in this regard.
I have taken note of your dissatisfaction with the application of rules and protocols on the Necesse benefit option. This benefit option is a low-cost network option in terms of which service providers are contracted by a network to render mostly primary healthcare and medicine lists (formularies), treatment protocols and pre-authorisation or registration processes apply to most services.
Medihelp offers different benefit options that members can choose from, each offering unique benefits and priced and structured accordingly. It is imperative that members must fami****ise themselves with the benefit composition of their chosen benefit options and the general rules and protocols on those options.
Your complaint has been forwarded to the relevant department for investigation and will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
PB
Pieter B's updateReviewer Update
20 Oct 2016, 16:19I'm sure I've read this response somewhere between the thousands of complaints posted by your members.
Thank you for responding computer.
PB
Pieter B's update20 Oct 2016, 16:19
Reviewer Update
I'm sure I've read this response somewhere between the thousands of complaints posted by your members.
Thank you for responding computer.
Medihelp's replyOfficial
25 Oct 2016, 07:57Dear PieterBuckle
The Rules of the Necesse benefit option stipulate that services must be rendered by general practitioners in Medihelp’s Necesse network and that pre-authorisation must be obtained for referrals to specialists prior to service rendering. Patients who refer themselves to specialists will be responsible for a 20% co-payment on the consultation, and no benefits will be paid for any other services or medicine rendered, requested or prescribed by the specialist. Blood tests must be performed by either Lancet or Pathcare.
Since you did not comply with the rules and protocols of the Necesse benefit option the account for services rendered by Ampath on 14 September 2016 cannot be considered for benefits and you will be responsible for payment of the account.
Kind regards
Medihelp Customer Care
Best regards,
Medihelp's reply25 Oct 2016, 07:57
Official
Dear PieterBuckle
The Rules of the Necesse benefit option stipulate that services must be rendered by general practitioners in Medihelp’s Necesse network and that pre-authorisation must be obtained for referrals to specialists prior to service rendering. Patients who refer themselves to specialists will be responsible for a 20% co-payment on the consultation, and no benefits will be paid for any other services or medicine rendered, requested or prescribed by the specialist. Blood tests must be performed by either Lancet or Pathcare.
Since you did not comply with the rules and protocols of the Necesse benefit option the account for services rendered by Ampath on 14 September 2016 cannot be considered for benefits and you will be responsible for payment of the account.
Kind regards
Medihelp Customer Care
Best regards,