1 reviews | Active since Jan 2014
Momentum does not want to cover a procedure they say they do
I am trying to get authorization for a Isotope CT scan at Lake Smit and Partners. I got a call from the lady at Lake Smit and Partners informing me that this procedure needs to be paid out of my health saver. I asked her why as no more than 3 weeks ago i had an MRI scan which was paid for no problem. I phoned Momentum and they told me that the codes that Lake Smit and Partners sent confirm a Isotope CT scan and that this was only covered from Health Saver because it is Out of hospital, if it was in hospital it would be no problem.
Why does Momentum try and find loop holes to evade paying for procedures and ignore their own binding contract!
Now what is confusing is that this is covered in the benefit that i am on, page 2 of the custom plan brochure contains the following wording : MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans (in- and out-of-hospital) No annual limit applies, subject to R2 500 co-payment per scan
Please explain
Kind Regards
Debbie
Kind Regards
Debbie
cholangiopancreatography (MRCP), whole body
radioisotope and PET scans (in- and out-of-hospital)
No annual limit applies, subject to R2 500 co-payment per
scan. On page 5 the following with regards to Day-to-day and health saver. MRI and CT scans, magnetic resonance
cholangiopancreatography (MRCP), whole
body radioisotope and PET scans
Covered from Major Medical Benefit, subject
to pre-authorisation and a co-payment of
R2 500 per scan.
Thus the only conclusion that can be drawn from these facts is that Momentum is not upholding the their end of the contract bargain by not covering something they say they do
cholangiopancreatography (MRCP), whole body
radioisotope and PET scans (in- and out-of-hospital)
No annual limit applies, subject to R2 500 co-payment per
scan. On page 5 the following with regards to Day-to-day and health saver. MRI and CT scans, magnetic resonance
cholangiopancreatography (MRCP), whole
body radioisotope and PET scans
Covered from Major Medical Benefit, subject
to pre-authorisation and a co-payment of
R2 500 per scan.
Thus the only conclusion that can be drawn from these facts is that Momentum is not upholding the their end of the contract bargain by not covering something they say they do