Momentum Health does not offer Professional & Competent Service

To whom this may concern, On the 4th of August the office of Dr. H vd Heever Inc (Pactice No. ***) sent in a PMB Application to Momentum Health.

This was after an emergency procedure was done on my Wife. The Administrator of the Drs’ Office advised that this was a PMB procedure that could be claimed for.

I paid the account/invoice in full and they sent the application in. On the 12th of August, we received an email from Momentum Health stating the PMB application was approved with an authorization number and ICD10 codes.

The Reference for that email was also given, which I cannot list here The PMB approved was for procedure codes: 0190, 3009, 3014, 3003, & 3029. With no further instruction or communication, on the 17th of August I sent an email to the claims department & consultant from Momentum Health who sent the email for the PMB authorization with all relevant info added on the email, As well as the Invoice, Receipt, Statement & my proof of payment from the Bank. On the 18th I received an email from a consultant stating they did not have the relevant information, and the claim would have to be processed from scratch, References for those emails: which I cannot list here After inquiring why they needed to start from scratch after there was an approval already. So instead of emails, I started phoning Momentum Health, one consultant after the other, every time having to explain this situation from scratch, and not getting anywhere.

I have been told by every single consultant they would phone me back, which has until today, not happened once. Eventually on the 23rd of August I received a claims processing email, stating that my claim was rejected because the ICD10 codes did not reflect on the Invoice. This was not true, so I resent the Invoice, and spoke to another consultant asking why they were saying that.

She proceeded to send the Invoice again, and therefore the claim started all over again. On the 26th of August, not receiving any communication from Momentum, I phoned again, and the consultant assured me the claim would be processed and sorted by the end of the 27th (Friday), which did not happen. which I cannot list here. On Sunday evening, the 29th of August, I received a Momentum claims processing email, where all the procedure codes NOT covered by the PMB approval was processed, and was scheduled to be paid by my Healthsaver? Which I did NOT ask for, or request! On Monday morning, the 30th of August, I phoned Momentum Health again trying to find out what is going on, spending 40minutes again explaining the entire story to another consultant. She then picked up that the claim had also been put on the wrong dependant code??

Which I could not believe, but she would escalate and get back to me to rectify, which did not happen. which I cannot list here Yesteday, the 31st of August, I phoned Momentum Health again, speaking to a consultant, explaining the entire story again as I have done so many times on the phone. While holding the line, she spoke to a claims specialist who said they would sort it out correctly and finalize the claim – she would also contact me back later in the day to give feedback, which did not happen. which I cannot list here At 12:47am yesterday morning I received a claims processing email, where all the procedure codes that fall under the PMB approval were listed, but the first two showed that they would be paid partially, and that is due to the fact that my Healthsaver has been depleted. And therefore the rest of the codes are showing non payment, and nothing to be paid from the Major Medical benefit. So it is the 2nd of September, 2 days short of a month since the application was sent in for PMB approval and processing, and yet this claim has still not been processed. I have sent emails 5 times and each time a different consultant, I have phoned Momentum Health 9 times on different occasions as per my call records – each call lasting between 9 – 21 minutes explaining the situation over and over again. I have provided the exact Invoice, the Receipt, & the Statement from the Doctor’s Office, in addition I have sent my proof of payment from my Bank Account – I have provided and done all, and yet still, only received minimum to none professional and helpful service. I am past the point of feeling angry and frustrated with my Medical Aid whom I pay promptly every single month to ensure cover for myself, my wife and my son – but honestly there has been no pride, no excellence in service received during this month. I request help from the Council for Medical Schemes & Hello Peter for some sort of resolution and result to have this claim processed and completed correctly.