Medihelp, cannot pay for basic codes written in the PMB guidelines for unstable angina. Will make your life a nightmare.

Medihelp simply cannot do basic coding and comply with the law om PBM codes and procedures. My father required multiple stents for his heart, yet Medihelp does not want to pay the network specialist they are contracted with for the stents. They declined all the codes, first needing a motivation (because the cardiologist would just put random stents into my dad's heart for fun and money) and now reject codes because "a second cardiologist cannot work on the same anatomy part" when the codes come LINE FOR LINE from the PMB guidebook for Unstable Angina that the Council for Medical schemes says you must pay.

Medihelp wants the doctors to change the codes to "assistant" which makes ZERO sense and seems very suspicious to me for a medical aid who wants doctors to change codes on valid PMB procedures.

It is beyond shocking that Medihelp will purposely stall processes and get in the way of the law that runs medical aids. Line for line the codes the cardiologist used on the invoice comes from the published guidelines for his ICD code. At this point it has become clear that Medihelp does not comply with the law and do not want to pay what they legally are obliged to pay.

This matter will be escalated to the Council for medical schemes as I have it all in writing that Medihelp cannot process codes correctly and refuses to do so. We will also be looking to move their medical aid to a competitor who I have never had these kinds of issues with and who is competent.

Medihelp is grasping at straws and will make your life hell (like all other comments on Hello Peter confirms), you will drown in bills due to their reluctance to pay basic codes, even for PMB heart conditions. Don't get cancer, don't get a heart problem.... you will be liable for the costs and they will come up with ridiculous (and *******) reasons to hope you will succumb and pay. This is how they operate and work and I will make sure the Council for Medical Schemes is aware of the ******* practices happening at Medihelp.