1 reviews | Active since May 2015
Go for surgery - thereafter we MIGHT pay...
As a follow-up to my previous complaint I want you to see exactly what Momentum Health wrote to me:
--------- Forwarded message --------- From: <***> Date: Thu, 03 Sep 2020, 09:14 Subject: RE: Request for authorisation: Bernard Tomé To: <***>
Good day Please note the attached x-ray report and motivation was reviewed by our Surgical advisor.
As per our Surgical advisor, codes 0667, 0614, 0746, 0747 and 0748 have been approved based on the radiology report.
Codes 0853, 0745, 0617 and 0615 has been declined, should the doctor still want to bill these codes the post-operative theatre notes can be sent in for review.
In other words they do not care about the doctor's diagnoses and will not approve these procedures BUT according to them the doctor must do it and thereafter they will decide if they will cover the cost.
Why have a medical aid then?
Do YOU want to take such a financial risk?
The reference number for your email is ***
Two things are clear here. 1) You do not trust the diagnosis of a professional doctor and 2) you were trying to cut corners in order to save money.
I had to get authorisation for my mother who has had the same surgery a week ago. She is with Discovery. They immediately approved everything. No reports were necessary, no advise needed from the CMS and no long phone calls and emails.
I can no longer be part of a medical aid that treat me like this. We are not just numbers. There are physical and emotional trauma involved with any surgery and you substantially added to this.
Two things are clear here. 1) You do not trust the diagnosis of a professional doctor and 2) you were trying to cut corners in order to save money.
I had to get authorisation for my mother who has had the same surgery a week ago. She is with Discovery. They immediately approved everything. No reports were necessary, no advise needed from the CMS and no long phone calls and emails.
I can no longer be part of a medical aid that treat me like this. We are not just numbers. There are physical and emotional trauma involved with any surgery and you substantially added to this.