They don’t care!

Working with Medihelp has been nothing short of a nightmare. Their lower fees initially seemed appealing, but the reality of using their hospital plan has left me incredibly disappointed and frustrated. My daughter sustained a knee injury, and after visiting a doctor, we were referred for an X-ray, followed by physiotherapy, and then to an orthopedic surgeon. She was diagnosed with a torn ACL, and in a state of urgency—due to her being in pain for months—I rushed to get an MRI done. I was aware of the R7,550 co-payment for the operation, which I was prepared for. However, things went downhill from there: I submitted a claim for the X-ray (R470), thinking it would be covered under the radiology benefit (R1,300), only to be told it's only for specialised radiology. I then submitted the MRI claim (R8,000)—which is specialised radiology—only to be told it wasn’t pre-authorised, and thus wouldn't be covered. They refused to cover in-hospital physiotherapy after the surgery, claiming it wasn’t authorised. How this wasn’t included when the hospital admission itself was authorised is beyond me. When I spoke to the accounts person at the physio and they mentioned that Medihelp is one of the worst medical aids to submit claims to as it is always a battle. What a reputation to have amongst service providers. The knee brace she was given during her hospital stay was also not covered because, according to Medihelp, the hospital plan doesn’t include apparatus—even when provided during surgery. So does that mean any essential medical device given during a procedure just isn’t covered? Post-surgery physiotherapy was meant to run for 12 weeks post surgery. Medihelp only paid for 2 sessions, taking the payment from our day-to-day benefit. Now that it’s depleted only in March, they refuse to cover the remaining sessions—even though there’s a separate post-hospital benefit. I sent an email to Medihelp to query this and it took them over a week to respond and still not giving me an answer 2 weeks later. To top it all off, I just received a bill from Netcare for R50 because Medihelp didn’t pay the full hospital stay invoice. Really? What is R50 from the R105000 invoiced? This whole experience has been a complete mess, and I regret ever choosing Medihelp. I am counting down the days to the end of 12 months, to avoid the waiting period with a new medical aid. I strongly advise anyone considering Medihelp to think twice before signing up. Cheap premiums are meaningless if the cover fails you when you need it most.