MEDIHELPS NON PAYMENTS ON PRE AUTHORIZED OP ON A NON NETWORK PLAN

I feel like all I do is complain about Medihelp these days! You guys pre authorized the entire procedure and only excluded roughly R2000 or R3000. Now I get this where you are only paying approximately R8600 of a R25k bill to the surgeon? I do not understand what is going on? So for this entire procedure, as a non network medihelp customer, whom pays their premiums on time every month, and a decent amount in premiums evrry month, by no means "cheap", that also does everything the correct way and gets all pre auths done and ensures to contact you prior to anything to get confirmations of everything, Medihelp is making me pay R40 029.89 out of pocket for this procedure??? In the amount of R16 316.57 that medihelp is not paying the ENT. EVEN THOUGH THIS WAS PRE AITHORIZED. R16 563.32 for the anesthetist. EVEN THOUGH THIS WAS PRE AUTHORIZED. R2000 Co-payment for the CT scan of a total of R2371. Also Pre Authirized. And R5140 Co-payment for the hospital.

This must be a joke.

Why am I paying your premiums, especially non network premiums? I made sure to select a non network plan, and you are still attempting to tell me the reason for your non payments is because the Doctors are not in your network. I SPECIFICALLY CHOSE A NON NETWORK PLAN AND MY PREMIUM REFLECTS THIS!! Why am I doing pre authorizations prior which confirm all things will be paid, only to be left with a bill at the end of everything??

This total situation cost R128 414.64 excluding medication which i also had to cover mostly out of pocket, in the amount of R940 odd of a R1100 bill even though they were given to me in hospital.

Medihelp has covered, on an entirely pre authorized procedure, on an entirely non network plan which I pay for, the amount of R86 309.82 - most of which was solely paid to the hospital and barely anything to the actual Doctors. And I am left with an outstanding bill of R41 733.92. Again which doesn't include the take home meds I paid most of the amount for from the hospital as well.

So you have paid 2/3 and I am liable for a third of this bill???

Preauthorized procedure? Non network plan?

You people need to rectify this and pay the Doctors the amounts!

I have accepted the co payment for the radiology even though it left me with R2000 bill out of R2371. And I have accepted the co payment to the hospital of R5140. But the Doctors??? I cannot accept that you are not paying the Doctors on a preauthorized procedure, which again was confirmed to me would be covered entirely except 1 of the ICD 10 codes which would have left me with approximately R2000 left to pay. No, on this Pre-Authorisation I owe more than R32 000 to Doctors, Paid R940 odd for take home meds bought to me in hospital, R5140 Co-pay to the hospital, R2000 Co-pay for a pre authorized CT scan for this procedure and R1600 of R1900 for the Dr consult required for the operation.

This needs to be solved immediately.

I am sick of medihelp making me jump through hoops and then just not paying.

If you are thinking of joining Medihelp, please ensure to read this review, it is pretty clear over view of how they work.