Medihelp is unreliable and doesn't assist you or validate their decisions. Instead you suffer!

Please see previous complaints about this situation too...

I have needed an Emergency Surgery since the 04-09-2020. It was at first completely declined.

Now after sending through all motivations and letters from the doctor an extremely large portion of the surgery was declined with NO REASONING. When the Dr's room had called in to Medihelp to question this, the case worker, WALTER, is extremely rude and abrupt, refuses to assist with any information and says that the Dr himself needs to call in to dispute this. As you should know that Dr's cannot sit all day trying to contact the call centre. The Dr's receptionist has tried and hasn't gotten any assistance in this matter.

When you ask to speak to the manager Leeya, they do not transfer your call. Walter takes your number down claims to send an email to his manager Leeya, however she never contacts you.

Medihelp is not assisting myself, my daughter or the dr's in this regard for my emergency surgery that is life threatening.

Details: 02-09-2020: Admitted into Sandton Mediclinic hospital successfully. Numerous of tests done to check and prepare for surgery. 03-09-2020: Approached Medihelp with details in regards to my surgery for authorisation. submitted all Motivations and letters from the Dr as requested. Called Medihelp at the following times: 09h46 11h42 11h51 12h00 04-09-2020: Contacted Medihelp for authorisation numerous times. Surgery was scheduled for 13h00. Contacted at: 08h33 10h08 11h36 Due to no response and and no Authorisation, surgery was cancelled and I was discharged and sent home from hospital in tremendous pain, swollen face (I have images to prove.) and limited medication. 08-09-2020: Contacted Medihelp for authorisation at 15h06, still no response to an authorisation. 09-09-2020: I went to the Dr for a check up and sent through more motivations and letters from my specialist through to Medihelp. Roughly around 22h00 I logged a complaint on Medihelp's online complaint forum. 11-09-2020: Logged a complaint online at the ombudsman for long term insurance 11-09-2020: Received an authorisation where roughly R 140 000 was declined. 14-09-2020: Dr's rooms have called Medihelp, rude and unwilling to assist. Want the DR himself to contact and dispute the declined procedure codes. 10h00 Called the medical aid to speak to CEO or manager about complaining and unhappy service regarding their authorisation assistance. Was again not assisted.

I would like a reason for the procedure codes: 0008; 0069; Rule J and 1060 being declined completely and a way for dispute as this surgery is necessary. I would need complete assistance in my authorisation for surgery for this week friday done ASAP