Momentum Health4Me ********

On 10/12/2020 I visited a network GP who referred me for blood tests that were to be done at Ampath, and informed me that these would be covered by Momentum Health4Me as part of my benefits, which I was also aware of ahead of time. The doctor gave me the Momentum document, ticked off the type of tests I required and I went to have the blood work done on the same day.

After the blood samples were taken, I also had another appointment with a Gastroenterologist specialist who I consulted with, where no procedures were performed and no requests or referrals were made for blood tests as I had just finished having the blood work done before meeting with the specialist.

The cost of the consultation was R1100.00 which I paid and would claim back from Momentum Health4Me as I had done with no issues before. I then submitted the claim on the 10/12/2020 along with the invoice, my ID copy and proof of my bank account and received an automated response with a reference number, advising that one of the consultants would be in contact with me withing 24 hours.

Nobody contacted me, and two weeks later I needed to call in to follow up, then was told that the claim was submitted to finance who added the claim to payments but did not add the claim file or proof that payment was made.

On the 13/01/2021, I received payment of R716.06 from Momentum Health4Me and immediately called the Client Care number where a consultant advised me that the R283.94 was not paid due to it paying for the blood tests I was referred to by the specialist? I went for blood work before I even got to the specialists office so please explain to me how the specialist could have referred me to have blood work done. The GP, Dr Britz completed the documents sent to Ampath and surely when claiming for their reimbur*****t, the name of the referring GP would have been noted on the invoice.

I called in on the 18/01/2021 and the consultant informed me that she would refer the matter to processing for feedback, then when I called again the 19/01/2021 I was told by Nkosi that feedback is available but states I would not be refunded the balance of R283.94 since the claim was paid to me at scheme rates and R283.94 was already paid for blood work when this should have come off my member benefits and not claims I have submitted?

My previous specialist visit was also for a consultation where I paid R740.00, submitted the claim and received a full refund as the member documents states that members are allowed 2 specialist visits per year, for up tp R1000.00 per consultation, with anything extra being the responsibility of the member, WHEN DID THIS CHANGE?! Answers, Momentum, answers. I do not get this product free of charge, its premium is deducted from my salary every single month so please refund the full amount that is due to me.