1 reviews | Active since May 2016
Not paying out claims submitted correctly
<p>On 31 May 2016 i had to go in for an unplanned C-section for the birth of my son. In April 2016 I already phoned the medical aid to authorise normal delivery of my son. On 30 May 2016 I was told by my gynie that I would need to have a c-section the follwoing day as my son was not growing and had to be taken out due to complications. I phoned the medical aid to change my planned normal delivery of my son to a c-section delivery with the ICD codes provided. The lady on the other side in the call centre assured me that everything willbe fine and she changed the whole authoriation with notes and everything.</p> <p> </p> <p>After the delivery I submitted my claim to Medihelp for the gynie's account to which they only paif out a portion of the amount stated and their reason for this was that it was an elective c-section. I did not elect to have a c-section, I was informed by my gynie that I had to get one as my son's live was in danger. I will not be held liable for an account that was supposed to be paid by the medical aid.</p>
Dear DDbokkie12
Thank you for taking the 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
Dear DDbokkie12
Thank you for taking the 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
Dear DDbokkie12
As telephonically discussed on 23 August 2016, your gynaecologist’s account for services rendered on 31 May 2016 was correctly paid at 100% of the scheme tariff. Medihelp informed you prior to service rendering, that your gynaecologist is not part of the Designated Network Providers (DSP). Furthermore, the diagnosis code (ICD-10) on the account does not confirm an emergency caesarean section.
As explained, when making voluntarily use of ‘n NON-DSP specialist the member will be liable for the shortfall in payment of the services.
Kind regards
Medihelp Customer Care
Dear DDbokkie12
As telephonically discussed on 23 August 2016, your gynaecologist’s account for services rendered on 31 May 2016 was correctly paid at 100% of the scheme tariff. Medihelp informed you prior to service rendering, that your gynaecologist is not part of the Designated Network Providers (DSP). Furthermore, the diagnosis code (ICD-10) on the account does not confirm an emergency caesarean section.
As explained, when making voluntarily use of ‘n NON-DSP specialist the member will be liable for the shortfall in payment of the services.
Kind regards
Medihelp Customer Care