MC
Martin C

1 reviews | Active since Jul 2015

08 Feb 2023, 13:46

Medihelp's new "day procedure" list they're not telling you about

I have a day procedure in mind, knowing it can be done at a day hospital.

I've verified beforehand that the specialist and day hospital is on the network provider list.

When the pre-authorisation was submitted, I'm charged a 35% penalty fee.

I phoned the pre-authorisation department. They said it's not the specialist or the day hospital, it's the procedures that aren't covered as "day procedures". I asked where I can view this list, and I'm forwarded to customer care. Customer care says no such list exists. I phone the pre-auth department again, where they now say there's no such list, and I have to phone them before I visit the specialist with the procedure codes to verify if it'll be covered.

So just to summarise, after using Medihelp's online network provider to ensure I'm using a network Specialist at a network Day Hospital, I now have to phone the specialist and hope they give me the procedure codes (which in the past they won't give me without a consultation), then I have to phone the pre-auth department to see if I'll be covered, then I have to see the specialist and hope the procedure codes remain the same.

The pre-auth department did confirm the "day procedure" exclusion criteria is something that Medihelp added recently in order to disadvantage their members even further.

I'm sorry but I've defended Medihelp long enough. I'm officially jumping ship to Discovery.

0
Replies (1)
Medihelp
Medihelp's reply08 Feb 2023, 14:14
Official
Dear Martin
 
Thank you for taking time to bring your complaint to our attention. The contents have been noted and we are currently investigating the matter.
 
The complaint will be responded to by one of our consultants.
 
Kind regards
 
Medihelp Customer Care