PZ
Pam Z

1 reviews | Active since Nov 2012

13 Mar 2018, 22:26

MEDIHELP NOT COMPLYING WITH PMB ACT GUIDELINES THEY'RE ARROGANT

Surely I'm no longer going to worry about what pmb confirmed conditions is medihelp attaching a copaynent to. Just like they just did with Dr kasunba's account. I've just realised that MEDIHELP HAS ACTUALLY BECOME ARROGANT AND THINK THEY ARE ABOVE THE LAW BY NOT COMPLYING TO THE PMB ACT GUIDELINES. I'M GOING TO MAKE IT MY PRIMARY PRIORITY TO MAKE SURE THAT THE PRINCIPAL OFFICER MR HEYN VAN ROOYEN IS AWARE OF WHAT IS HAPPENING BEHIBD THE SCENES. I WILL MAKE SURE THAT I BRING THEIR ARROGANCE TO ITS MEMBERS THROUGH THE MEDIA. I WILL NOT WASTE MY TIME WITH SAMA OR CMS BUT I'M A WAY OR THE OTHER I WILL EXPOSE MEDIHELP PRACTICES. THIS MEANS THEIR POOR MEMBERS AGO ARE NOT FAMI**** WITH PMB GUIDELINES ARE MADE TO PAY COPSYMEBTS. I WILL AS FAR AS DRAGGING POLITICAL PARTIES TO THIS ISSUE I'M SURE SOME WILL BE INTERESTED IN MAKING THIS A POLITICAL CAMPAIGN! I'M NOT HOIBG TO REQUEST FOR PATHOLOGY REPORTS TO DUBMIT TO CONFIRM PMB CONDITION ON BIOPSY LAPSCOPE. YOUR ARROGANCE WILL END SOON

0
Replies (8)
Medihelp
Medihelp's reply15 Mar 2018, 09:16
Official

Dear PHELADI.Z

It is important to understand that Medihelp has a responsibility to protect the interest of all its members by managing its costs. This includes the management of Prescribed Minimum Benefits (PMB), which can have dire affects for a medical scheme if not controlled.

PMB is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. Managing the complexity of PMB services can sometimes be cumbersome but is necessary to ensure the long-term sustainability of Medihelp.

We have requested more information from the medical service providers involved and feedback will be provided as soon as the information is received.

Kind regards

Medihelp Customer Care

PZ
Pam Z's update15 Mar 2018, 14:17
Reviewer Update
I don't care what you do to correct this. JUST REVERSE ALL PMB RELATED CLAIMS PAID FROM MY SAVINGS
PZ
Pam Z's update19 Mar 2018, 22:08
Reviewer Update
Tomorrow 20th is the 2nd pay run date and since the 15th March after this HP response NO ONE HAS PROVIDED ME WITH SATISFACTORY RESPONSE.
PZ
Pam Z's update19 Mar 2018, 22:08
Reviewer Update
Tomorrow 20th is the 2nd pay run date and since the 15th March after this HP response NO ONE HAS PROVIDED ME WITH SATISFACTORY RESPONSE.
PZ
Pam Z's update19 Mar 2018, 22:08
Reviewer Update
Tomorrow 20th is the 2nd pay run date and since the 15th March after this HP response NO ONE HAS PROVIDED ME WITH SATISFACTORY RESPONSE.
PZ
Pam Z's update19 Mar 2018, 22:08
Reviewer Update
Tomorrow 20th is the 2nd pay run date and since the 15th March after this HP response NO ONE HAS PROVIDED ME WITH SATISFACTORY RESPONSE.
PZ
Pam Z's update20 Mar 2018, 10:14
Reviewer Update
I've now emailed the same pathology reports which were emailed to ********** on the 15 March 2018 by Sr Gloria from Dr Muzamhindo' rooms. Today upon responding to my HP follow up you confirmed you're still awaiting theses reports. You service sucks and you are reactive instead of being pro active. I've now forwarded the same results to jvorster, claims, enquiries and new business emails. I expect ALL claims to be processed today on the 2nd pay run date without co-payment and paid in full without " tariff exceeded " rule. Pathology confirms DTP PMB conditions.
PZ
Pam Z's update22 Mar 2018, 08:29
Reviewer Update
Affter the same pathology reports confirming DTP PMB Conditions on 15th March and resend to Jacques vorster on 20th March, instead of processing the claims and finalising them and accept his error of not attending to these reports on the 15th , 5 days later he now wants PCR RESULTS. could be have attended to this results same day and request the pcr which in my clinical opinion the results will remain the same. I hope Jacques Vorster has an MBCHB WITH RAD AND FCP (SA) qualification cause even your medical advisor will not request pcr following what the lapscope report confirmed. I will settle this with CMS