Medihelp Not Paying Valid Approved Claims!!

On 9/01/2023 my wife and myself was referred to Hamadi Pathologists for requested blood tests by our Medihelp Network GP. Later on my statement I noticed that two (2) specific item codes that is part of our PMB Basket of Care was not paid.

I called in to the Medihelp Customer Care Center on 23/01/2023 at 8:21 and logged a query regarding these two (2) item codes. (4482 for myself and 4027 for my wife) On 1/02/2023 I called in again at 13:32 to follow-up and was told that they are busy with my query.

On 13/02/2023 I sent them an email requesting their urgent attention regarding this matter and that I will be referring this to The Council for Medical Schemes if they don't respond soonest. They responded via email on 22/02/2023 giving me a LESSON on how my specific plan works. (I know how my chosen plan works and I only requested payment on the specific items that I know is covered and not paid). They however confirmed that the specific items was approved and that it will be paid by the next payment run.

On 3/03/2023 I received my statement and noticed that only item 4482 for myself was paid and item 4027 for my wife was not with reason code 009 (No Benefit). Maybe I must give them a lesson on how my specific plan works and what is covered under approved PMB Basket of Care?!!