JOIN MEDIHELP AND YOU WILL HAVE TO FIGHT FOR YOUR RIGHTS

JOIN MEDIHELP AND YOU WILL HAVE TO FIGHT FOR YOUR RIGHTS !

Quote" B P Goodwood Cape Town 19 October 2019 To: Medihelp Attention: CEO of Medihelp

It is without surprise that we got notified on the 18th of October of the denial and rejection form to our hospital pre-authorization application of 14th of October. Your conclusion and decision to reject the pre-authorization is flawed and wrong and I will explain myself. You have used the term “Chronic” disease of tonsils and adenoids, unspecified. And you are wrong to have used this as an excuse to deny the pre-authorization. You are making a conclusion that is false by stating that we did not declare a pre-condition or “pre-condition not declared to scheme by member??? Let me explain… In our application for our hospital plan with Medihelp we had NOTHING to declare in terms of conditions that needed to be disclosed, because there were none. Pet P is a healthy little girl that just like everyone’s kids will have the occasional flue and sore throat that comes with or without a fever and sore bones. This condition is common to everyone and did not require any disclosure. We spoke to all the Doctors including Dr V, Dr Z, more than one Pharmacist that we spoke to and the public and finally your own consultant I recall mentioning that she gets an occasional flue and that is it and all agree that there is not need to disclose that condition. Pet P had at the time of application and approval on the scheme about 5 months ago no conditions that needed any disclosure. Although we Pet P had once upon a time and before the application to join Medihelp a sore throat that was a once off event in 4 years and we are not qualified to use the term tonsilitis because we are not Doctors was an event that is clearly not Chronic (Chronic is a Greek term that means repetitive at time sensitive intervals). This to us was clearly not a pre-existing conditions as it was a once off occurrence. It is only while she was on the scheme and during the consultation with Dr T that for the first time, we were told that her tonsils needed to be removed to avoid a reoccurrence of an inflammation of the tonsils and the bad breath that is associated to this condition. I would like to make it clear that is was the first time that we got such news of the need to remove her tonsils and adenoids and clearly there was NO PRE-EXISTING CONDITION at the time of the application and you need to refrain from creating a condition that never existed as a reason for the rejection of the pre-authorization. We are not Doctors and clearly in our eyes there were no conditions that were of the level or magnitude that required a disclosure. I feel that your process of application is flawed (This applies to most Medical Aids) You ask from the public who are not medical professionals if they have a condition to declare and then come up with medical terms and use those to exit your obligations? Why do you not investigate your prospective clients by requiring medical records before you take clients on board? Surely that would be more reliable and eliminate this flawed process whereby you initially act like you trust your clients and accept them on the scheme and when it comes to have to pay out something you then decide to investigate and put your client’s words in doubt is sickening! As Authorities are looking to reform this distorted industry, I would like legislators to look at this loophole that medial aid are exploiting to cash in the publics contribution and then pull out a rabbit out of their hats to evade their obligations, this is a comedy! Also I need to state that whatever recordings you may have of my wife N P’s telephone conversation with your rude staff the day that she discovered that you were investigating the pre-authorization and would not authorize the operation for that coming Monday threw my wife in a total panic and became incoherent in her conversation and was speaking under duress. Because N P was speaking in panic and under duress anything that she said cannot be used against here and if you try it will expose the length that you go to to evade your obligations. Also, N P my wife is not a doctor and represents a lay-person with regards to medial issues. The day of the consultation with Dr T some medical words were used but clearly if N P used them over the phone, she is not qualified to state them and those do not represent a medical disclosure or medical diagnosis of any form and shape as she is not a Doctor. It turns out that subsequent to the scheduled operation that P Pet was put on antibiotics to cure or reduce the inflammation and that an operation to removed her tonsils and adenoids has to be re-scheduled once she completes her current treatment. Based on the above assessment we hereby demand that you proceed with the pre-authorization for the removal of her tonsils and adenoids to avoid a reoccurrence of this condition in the future. The date of the operation however must still be set. I am not sure if you had arrived at a final conclusion and therefore will give you the benefit of the doubt and wait for your final answer. Also, should you persist with a negative answer, we demand complete clarity because it is of public interest how this matter is concluded.

B P Unquote "