Medihelp Bad Service

My Mother was a member of Medihelp Medical aid for more than 40 years. Last year she fell and dislocated her hip. We took her to Sunward Park hospital for emergency medical assistance as she was incapacitated and in great pain, she could not sit properly or stand on her own from the dislocation. She was told they will manipulate the hip back into position under anaesthesia. This was done and she came home. Two weeks later the hip dislocated again and she was in pain and struggled with this over Christmas time as her doctor was unfortunately on leave. (With “struggled” I mean – she was bedridden, unable to move freely by herself or assisted with her walker frame)

On the 2nd of January we took her back to the hospital and once again the hip was manipulated back into position under anaesthesia. Two weeks later the happened again, she was in a sitting position and could not get up, dislocated again . This time the Doctor decided to replace the prosthesis she had with an improved one that will prevent dislocation and deemed more stable . (3 times in two months my mother had to endure this excruciating pain and discomfort as a 79 year old elderly Lady )

Upon final diagnosis of a hip replacement we asked the hospital to get authorisations for all procedures before they are to do anything as this was a medical aid requirement. This process was done through the hospital on behalf of my mother as she requested. She stressed the importance of getting the necessary pre- authorisation before going into surgery as she was in no position to pay for the procedure herself and had medical aid for this purpose for unforeseen events. My Mother sadly passed away in March and currently Medihelp is refusing to pay for the hospitalisation and theatre bills as they say this incident is due to negligence???? Please explain to me how you can treat a customer of yours (Over 40 years membership ) a 79 year old lady by saying it was negligence, furthermore the medical aid does not want to deal with the relatives in engaging in communication to better understand for what exact reason they base their refusal to settle the hospitalisation and theatre bills, they paid the minimum settlement to pay the doctor and currently have this excessive bill they expect us to settle ?

I find this unacceptable and feel victimised in the sense that they are taking this unexpected stance after we had asked for all procedures to be adhered to in order not to be liable and placed in this financially awkward and highly stressful predicament. Unfortunately the main member is deceased and the medical aid is taking advantage of this misfortune by refusing to talk to anyone but the main member, and taking this stance …. Where to and what to do from here on ? ?