Ridiculous
<p>After 10 years with Medihelp, I'm about to move on after a 6 month battle to get a claim paid!! Bear in mind that I'm the type of client who visits a doctor perhaps once a year, has no chronic medicine and pretty much costs the scheme nothing while contributing almost R2000 every month...on time!! But having to deal with differerent people every time you call or mail and their standard cut-and-paste answers that a robot could provide has left me feeling very "unheard" re my claim. The worst part is that they insist on an unnecessary protocol: see your gp, get referral to specialist [they only pay 50% of this visit] and then visit physio). Not repeating this process two months after the initial diagnosis, because the physiotherapy has fallen outside of this 6 week period for which you are authorised to visit said physio means that your claim won't be paid!! News to me.....I thought I was busy with a slow process in building up hip strength to avoid surgery!! Maintaining that it's an on-going process means nothing, no no, you need to start the whole thing again so that you can waste money as well as everybody's time!! Can these people just apply their mind!!</p>
Dear wilma-jansen-van-veuren
Thank you for taking the time to bring your complaint to our attention. Medihelp puts a high premium on effective communication with all its clients and appreciates any feedback that we receive in this regard.
I have taken note of your dissatisfaction with the application of rules and protocols on the Necesse benefit option. This benefit option is a low-cost network option in terms of which service providers are contracted by a network to render mostly primary healthcare and medicine lists (formularies), treatment protocols and pre-authorisation or registration processes apply to most services.
Medihelp offers different benefit options that members can choose from, each offering unique benefits and priced and structured accordingly. It is imperative that members must fami****ise themselves with the benefit composition of their chosen benefit options and the general rules and protocols on those options.
Your complaint has been forwarded to the relevant department for investigation and will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
Dear wilma-jansen-van-veuren
Thank you for taking the time to bring your complaint to our attention. Medihelp puts a high premium on effective communication with all its clients and appreciates any feedback that we receive in this regard.
I have taken note of your dissatisfaction with the application of rules and protocols on the Necesse benefit option. This benefit option is a low-cost network option in terms of which service providers are contracted by a network to render mostly primary healthcare and medicine lists (formularies), treatment protocols and pre-authorisation or registration processes apply to most services.
Medihelp offers different benefit options that members can choose from, each offering unique benefits and priced and structured accordingly. It is imperative that members must fami****ise themselves with the benefit composition of their chosen benefit options and the general rules and protocols on those options.
Your complaint has been forwarded to the relevant department for investigation and will be responded to by one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
And there we go again....a completely impersonal message that was probably an auto-response from some random computer. So there'll be another faceless consultant that will have to be told the whole story....why did I expect any kind of understanding or rather the application of a sound mind......
And there we go again....a completely impersonal message that was probably an auto-response from some random computer. So there'll be another faceless consultant that will have to be told the whole story....why did I expect any kind of understanding or rather the application of a sound mind......
Dear wilma-jansen-van-veuren
I appreciate your careful management of your medical aid benefits, but as a member of the Necesse network option you are required to follow certain protocols in order to qualify for benefits.
As explained by phone on 29 September 2016, your Necesse network GP is the primary point of access to all medical services, including specialist consultations, medicine, physiotherapy, radiology and pathology. Your network GP must therefore refer you to a specialist or a physiothe****** if necessary, otherwise the services will not qualify for benefits. The referral is only valid for a certain period during which you should obtain the services, and if you are unable to do so you must obtain a new referral. Authorisation for any treatment is only granted until the end of a book year, as new benefits might apply in the next book year. If services need to continue in January of the following year, the member must confirm with the Scheme whether the authorisation will still be valid.
Medihelp paid for the physiotherapy services requested by your Necesse network GP but not for the services requested by the specialist, as you were not referred to the specialist by your network GP as is required by your benefit option’s protocols.
Regarding your complaint that you have to deal with different people every time you contact the Scheme, you should note that when we receive an enquiry we assign it electronically to the first available consultant, to ensure that it is handled promptly. We do not allocate specific consultants to handle specific clients’ enquiries, as this might result in delays. Thus, it is likely that your enquiry will be handled by a different consultant every time, but I assure you that all our consultants are equipped to handle your telephonic or written enquiries.
Kind regards
Medihelp Customer Care
Best regards,
Dear wilma-jansen-van-veuren
I appreciate your careful management of your medical aid benefits, but as a member of the Necesse network option you are required to follow certain protocols in order to qualify for benefits.
As explained by phone on 29 September 2016, your Necesse network GP is the primary point of access to all medical services, including specialist consultations, medicine, physiotherapy, radiology and pathology. Your network GP must therefore refer you to a specialist or a physiothe****** if necessary, otherwise the services will not qualify for benefits. The referral is only valid for a certain period during which you should obtain the services, and if you are unable to do so you must obtain a new referral. Authorisation for any treatment is only granted until the end of a book year, as new benefits might apply in the next book year. If services need to continue in January of the following year, the member must confirm with the Scheme whether the authorisation will still be valid.
Medihelp paid for the physiotherapy services requested by your Necesse network GP but not for the services requested by the specialist, as you were not referred to the specialist by your network GP as is required by your benefit option’s protocols.
Regarding your complaint that you have to deal with different people every time you contact the Scheme, you should note that when we receive an enquiry we assign it electronically to the first available consultant, to ensure that it is handled promptly. We do not allocate specific consultants to handle specific clients’ enquiries, as this might result in delays. Thus, it is likely that your enquiry will be handled by a different consultant every time, but I assure you that all our consultants are equipped to handle your telephonic or written enquiries.
Kind regards
Medihelp Customer Care
Best regards,
I'm not going to continue with this conversation, because I realised some time ago that you are obviously unable to deal with this kind of enquiry. Should you have a supervisor, I would like to rather hear from him. Clearly you have not looked at my complete "case" (which you supposedly document for the next minion to deal with this issue in a "speedy" inefficient manner), because as you well know, I did start the process correctly by going to my GP. What you're quoting as general knowledge supposedly available to the client is news to me and is not contained in your benefits handbook (in other words: to check whether authorisation is valid at the start of a new bookyear and the fact that the referral to the physio is only valid for 6 weeks). The text message sent to me after a very frustrating telephone call with another employee who needed the whole saga spelt out to him again, did not make this clear either and there is absolutely nothing on page 10 of the handbook (which he referred me to) about the difference between the procedure and funds available for a referral from a specialist as opposed to the GP. This truly is a lesson in "how to antagonise your clients"!!
I'm not going to continue with this conversation, because I realised some time ago that you are obviously unable to deal with this kind of enquiry. Should you have a supervisor, I would like to rather hear from him. Clearly you have not looked at my complete "case" (which you supposedly document for the next minion to deal with this issue in a "speedy" inefficient manner), because as you well know, I did start the process correctly by going to my GP. What you're quoting as general knowledge supposedly available to the client is news to me and is not contained in your benefits handbook (in other words: to check whether authorisation is valid at the start of a new bookyear and the fact that the referral to the physio is only valid for 6 weeks). The text message sent to me after a very frustrating telephone call with another employee who needed the whole saga spelt out to him again, did not make this clear either and there is absolutely nothing on page 10 of the handbook (which he referred me to) about the difference between the procedure and funds available for a referral from a specialist as opposed to the GP. This truly is a lesson in "how to antagonise your clients"!!