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ZM
Zanele M

1 reviews | Active since Jan 2013

02 Aug 2018, 14:08

Medscheme's inconsistency/negligence resulting in financial loss and possible ********** attempts.

Medscheme had given authorisation for a medical procedure as per quote provided by the Specialist in May 2018. I had to pay the Specialist in full and claim from Medscheme.

Post the procedure and about 30days of waiting for the refund, I was reimbursed a shocking 25% of the total claim! I logged a formal complaint on 12 July 2018 with Med Ass of SA to no avail. Medscheme have still sent me a statement reflecting a non-payment but no reason why they approved the amount for the procedure but not settling the claim now.

Unsettling is the fact that I had to alert Medscheme of a ********** pre-authorisation request (on behalf of my son who's a minor, as had the procedure done 4years ago) as I received an 'approval' from them...disturbing negligence.

0
Replies (5)
Medscheme
Medscheme's reply03 Aug 2018, 09:27
Official

Good day Zanele

Thank you for submitting a comment to us through Hello Peter.

This email serves to confirm that we have received your comment.

We, however, need further information, such as:

Medical aid number
Ref number
Agent you spoke to
ID number


We trust that we will hear from you soon so that your complaint can be dealt with promptly.

Kind regards
Medscheme Team

ZM
Zanele M's update03 Aug 2018, 11:16
Reviewer Update
Mescheme Team.. Please advise me of email address to send the info to. Thank you
ZM
Zanele M's update10 Oct 2018, 12:30
Reviewer Update
I had to follow through with Medscheme as they had not provided a contact person that the issue was escalated too. Another 20% of the total claim was paid after the said 're-review' in August post the on the escalation on Helloper.com ...making the total refund a mere 40% of the approved claim. The million dollar question is WHY DID MEDSCHEME APPROVE THE DOCTOR'S QUOTE FOR R5800, KNOWING THAT THEY WILL NOT REFUND ME THE FULL INVOICE. The Doctor only went ahead with the procedure because he was comforted that I would be refunded in full. It's only that his practice is 'cash' and patients thereafter claim from their medical scheme.
Medscheme
Medscheme's reply10 Oct 2018, 13:50
Official

Thank you for submitting a comment to us through Hello Peter.

This is to confirm that we have received your comment and that we are currently investigating this matter.

Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.

Kind regards
Medscheme Team

ZM
Zanele M's update13 Dec 2018, 14:41
Reviewer Update
Medscheme team...I had to prioritise my studies but shockingly the refund has not been revised and refunded in full. The principle question is WHY DID MEDSCHEME APPROVE THE DOCTOR'S QUOTE FOR R5800, KNOWING THAT THEY WILL NOT REFUND ME THE FULL INVOICE.