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zanele N

1 reviews | Active since Sept 2014

20 Mar 2018, 18:03

Complaint re- copayment

I would like to express my dissatisfaction with this medical aid. First and far most I would like them to provide me with a definition for emergency and criteria used to approve authorization without co-payment. I had a severe allergic reaction to unknown allergen and presented with swollen face,neck and low blood pressure and according to the scheme that is a nonemergency but routine admission. Momentum, please provide your response on this platform for all of us to understand.

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Replies (2)
Momentum Health
Momentum Health's reply22 Mar 2018, 08:30
Official

Thank you for bringing your concerns to our attention.

The matter will be referred to the medical aid department in order to assist you.

Kind regards

Natasha

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zanele N's update23 Mar 2018, 13:25
Reviewer Update
I received a call from Momentum to address the stated complaint, however I am still not answered as to what is their protocol/ SOP when it comes to admissions especially via casualty. what is your definition of emergency and criteria used? The hospital case manager called pre-auth department and provided clinical information and reasons for admission. That was not enough, I as a patient had to be wheeled to the reception as weak as I was to explain to Sam the nature of my condition who advised that my condition was not an emergency since there were no results available as yet although clinical information and vital signs were provided. Furthermore I was told that the case manager will review the clinical information and decide whether co-payment will be app**** or not. I was shocked yesterday when I was requested to get clinical information from the casualty officer who treated me on admission, like seriously what is the role of the case manager if I have to be the one requesting the information? Further to that my case is pending doctor's report for review, what is the role of pre-auth and case manager?? I am more than disappointed with the scheme as they don't seem to be able to provide detailed clarity on their protocol and criteria used and I say this with reference to my previous admission where tests were done and showed that I had high allergy levels which caused the body rash but according to the scheme that was not an emergency since there was no respiratory distress. I was admitted via casualty and the pre-authorization letter states that I chose a non-network provider as my doctor. How was I supposed to choose a network doctor in this situation? Please provide detailed feedback that will also address issues regarding my previous admission and prepare me for future . Thank you..