1 reviews | Active since Feb 2014
Medihelp not taking responsibility for mistake
My wife went to the network doctor that medi help recommended to us. The doctor (Dr De Wet Bergh)(PR no. ***) prescribed meds witch is not covered by the medical aid. This we only found out when we got to the pharmacy and had to pay cash. After revering this matter to the medical aid they did investigation and found that they and the doctor where at fault. See e mail response below.....<br> ( The Necesse acute medicine formulary was sent to the practice of Dr S Louw & Assocoates Incorporated as requested by their representative Monique.<br> A meeting between Medihelp's network representative and the practice was requested.<br> The practice requested that the Necesse network benefit option be explained to them in detail to ensure they comply with all the stipulations required.)<br> So... a meeting will take place between medi help and the Docter to explain what meds he can prescribe.Should he not know this before he becomes part of the network????? Thank you medi help for admitting you are at fault and then doing NOTHING about it!!!
Necesse is a network option which relies on compliance to a network of general practitioners, medicine formulary, specialists referrals and network hospitals. This makes the option so affordable considering the range of services covered and benefit richness of the option. Doctors receive a guide containing formularies and processes relevant to the option, while members receive their guide every year. In cases such as this where your wife visited a new doctor who only recently joined the group practice, one can understand the doctor might not have been informed yet of all the requirements of the different medical schemes - of which there are 83 open schemes with as many as 10 benefit options each. We have since visited the practice to provide them with all the information they might require.
Medicine not on formulary prescribed cannot be reimbursed by the Scheme, as this is part of the Rules of the option. Thank you for bringing the matter to our attention and alerting us to the fact that new employees/doctors might not be aware of the rules of the option. We will follow up with a newsletter to other Necesse doctors as well.
Kind regards
Medihelp Customer Care
Best regards,
Necesse is a network option which relies on compliance to a network of general practitioners, medicine formulary, specialists referrals and network hospitals. This makes the option so affordable considering the range of services covered and benefit richness of the option. Doctors receive a guide containing formularies and processes relevant to the option, while members receive their guide every year. In cases such as this where your wife visited a new doctor who only recently joined the group practice, one can understand the doctor might not have been informed yet of all the requirements of the different medical schemes - of which there are 83 open schemes with as many as 10 benefit options each. We have since visited the practice to provide them with all the information they might require.
Medicine not on formulary prescribed cannot be reimbursed by the Scheme, as this is part of the Rules of the option. Thank you for bringing the matter to our attention and alerting us to the fact that new employees/doctors might not be aware of the rules of the option. We will follow up with a newsletter to other Necesse doctors as well.
Kind regards
Medihelp Customer Care
Best regards,