NT
Neville T

1 reviews | Active since Feb 2014

04 Oct 2016, 08:56

Hard working humans still being abused by parasites incabable of accountability, integrity, usefulness.

<p>Like normal the big organizations take pride in being able to exploit and abuse there clients, and large medical aids will side only with medical professionals who are parasitical gangsters and ******* like themselves, knowing that they will always get away with it, because we are powerless to do anything about it. Ombudsmen and policing organizations as parasitical, ******** and *****ed as the people that they are supposed to police. Playing lip service to any real constructive action and ensuring the lying advertisments about them always proclaims the opposite of what actually happens. </p> <p>I went to an optician (Sunil Mahadev, Southway mall), who submitted a claim to my medical aid which was vastly more expensive to what they had quoted me, and asked the medical aid to stop it (this within 18 hours of having seen them). I stopped the spectacles from being made and cancelled the contract with the so called professional paying cash (60% less than the medical aid charge) for the eye test consultation, being the only fee the optician was now entitled to. He informed me that the he had cancelled the claim to the medical aid. </p> <p>The medical aid informed that the professional did not need to get any sort of authorization from me, and once they had my details they could submit what ever they liked.(Customer service?) The following day I received a notice from my medical aid saying that they had processed his claim on me account. I again phoned them and was assured that they informed me (normally as soon as possible after a claim), so that I could dispute it as there was no real authorization process with them, and that it was in fact *******, for him to have submitted the claim before performing the actual service of manufacturing the glasses and suppling them to me. I also emailed the enquiries and audit department and received a reply from a Andaleen Krieg who confirmed they would stop the payment and investigate the professional.</p> <p> The opticians informed me that they had been informed that they had to send a credit note request now, which they had done and gave me a reference number. This all happened over two weeks ago and I have since already received my spectacles from a different optician at a 40% discount on the original optomitrists cash price and 60% of the price he wanted to charge my medical aid, but the original optician was still paid and the money deducted from my savings account at the end of September.</p> <p> </p>

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Replies (1)
Medihelp
Medihelp's reply04 Oct 2016, 13:40
Official

Dear ntee

Thank you for taking the time to bring your complaint to our attention. Medihelp strives to render an efficient service to all members, but it is clear from your complaint that you did not experience the same high quality of service to which our members are accustomed and I apologise for any inconvenience that was caused in this regard.

Medihelp received Mr Mahadev’s claim for spectacles electronically on 20 September 2016. His office contacted the Scheme the following day on 21 September 2016 and informed us that the claim should be reversed as you have cancelled the spectacles.

At that time, Medihelp had already started to prepare the electronic claim for assessment. Due to an administrative error Medihelp did not cancel the claim in time and it was therefore paid as a valid claim from the available amount in your medical savings account. Medihelp reported this payment of R2 330 on your summarised claims statement dated 30 September 2016.

Medihelp will now urgently reverse the payment and credit your savings account with the amount of R2 330. We will confirm the transaction on your next claims statement.

Kind regards

Medihelp Customer Care