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sonwabojekeqa S

1 reviews | Active since Aug 2010

19 Jul 2015, 22:03

Block benefit and Casualty unit

On the 2nd of July 2015, I rushed my partner to the casualty unit at St Georges hospital as we had an emergency. The hospital claimed and the account has been successfully paid from the Block Benefit as a result, the hospital account exhausted her Block benefit. In between the hospital claim from St Georges there was also a claim for the medication that she received from the hospital as a TTO but to my surprise, this claim was released to be paid from the Block benefit and not acute medication benefit. The casualty Doctor also requested for blood samples which was taken by Pathcare laboratories, they also submitted their claim which normally is paid from the acute medication benefit, but GEMS went on and clustered this claim for payment from the Block benefit. I'm not too sure why there was a problem with benefit alocation regarding this emergency visit to the hospital. Obviously it is only fair that benefits be allocated accordingly so as to avoid patients having to dig deep into their own pocket for benefits they have. I would appreciate it if somebody from GEMS could assist.

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Replies (1)
Metropolitan Health Group
Metropolitan Health Group's reply18 Aug 2015, 11:56
Official
Hello jekeqa,

Due to fact that the patient was not admitted to the hospital, but treated as an outpatient, the account was correctly settled from the day to day block benefit.

We confirm that we have provided you with telephonic and written feedback.

Kind regards
The Metropolitan Health Team