Extremely long turnaround times on claims and staff not listening to you as a client

I am highly frustrated with the turnaround times on the hospital claims. I am in the unfortunate position where I almost have monthly hospital admission, that result in co-payment upon co-payment. And these co-payments are not just applicable to the hospital, it is also on radiology as well as procedures. So in one month you easily pay up to R10 000 out of your pocket on these co-payments. So I expect to have these claims settled as soon as possible in order for me to have it on my medical aid statement so that I can claim from GAP cover.

If I don't get the claim settled from GAP cover, then I run out of pocket before I need to pay my next batch of co-payments. There was a claim from Mediclinic Louis Leipoldt that was on the system pending from early June for hospital dates of 8 May. So with the statement run of 14 June, I expected for the claim to be finalized so that I can have my statement so that I can claim from GAP cover, which is by the way Admed (Guardrisk) which is part of the Momentum Group. With great disappointment the entry was not on the statement.

And Admed is not finalizing the claims if you do not have the authorization letter, proof of co-payment, hospital bill and medical aid statement. So the medical aid statement is the only outstanding document that I anxiously waiting on.

I even asked the medical aid for a letter from the medical aid that should replace my statement so that I can claim from GAP cover. However Admed is not accepting this . They flippen need the medical aid statement!!!! This is ridiculous. So I waited patiently for the statement run of 28 June and yet to find that the claim from Mediclinic Louis Leipoltd dated 8 May is still not on the statement. So yet again, I cannot claim this co-payment. According to the claim the payment to Medic clinic Louis leipoldt was suppose to be on 21 June. So why could this entry not be on my 28 June statement?!!!!!

Then the new claim dated 10 June is also on my records but it was not finalized by the medical aid and also not on my 28 June. And when I phone the consultants they just don't freaken care because this is just another client and it is not their money they are dealing with.

And what I do not understand is that the Momentum Health is charging all these co-payments and my GAP cover is from Admed, Guardrisk, which is also part of the MOmentum Group. So if Admed need to pay me the co-payment, or Momentum Health waive the co-payment and pay the full amount to the vendor, the expense is still within the group. It just makes us as the client poorer. So I think Momentum Health should also seriously reconsider their co-payments if they client has their GAP cover also from the same MOmentum Group. Even so to speak when it comes to staff members.

I don't even know what your answer will help. Because as long as I don't have my medical aid statement with these entries it will still help me nothing. And as long as Admed is so stubborn to not process my claim based on the letter from the medical aid, I am still stuck without money. We are probably just another number and the staff working with these claims work so according to their little check list that they can't think for themselves and make exceptions to help clients.