CF
CornAA(C) Fourie
1 reviews | Active since Nov 2012
15 Oct 2021, 17:22
Please help me
Could you urgently please assist me since I have had an ongoing battle since March 2021 ? My Momentum membership number is *** My daughter had to undergo a procedure at Milpark Hospital and a pre-authorisation number was received from Momentum Health ( number *** ) - I have proof thereof. Momentum required 2 extra documents after the procedure was done before they would pay Milpark Radiography. This was submitted but no payment was made. I have now received a letter of demand with the final statement costing an extra R114.00. I pay a monthly membership of R13 403.00 to ensure that costs like these are covered an now Momentum is not paying the service provider. I do not know what else to do.
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Replies (3)
Momentum Health's replyOfficial
18 Oct 2021, 11:26Dear CornA
As mentioned during our discussion your query is currently being reviewed and we will revert witl feedback.
Kind Regards
Debbie
As mentioned during our discussion your query is currently being reviewed and we will revert witl feedback.
Kind Regards
Debbie
Momentum Health's reply18 Oct 2021, 11:26
Official
Dear CornA
As mentioned during our discussion your query is currently being reviewed and we will revert witl feedback.
Kind Regards
Debbie
As mentioned during our discussion your query is currently being reviewed and we will revert witl feedback.
Kind Regards
Debbie
CF
CornAA(C) Fourie's updateReviewer Update
28 Oct 2021, 08:14Good morning Debbie
After months of trying the 2 businesses to communicate to one another regarding an approved authorisation I receive the following feedback, as well as our calls requesting only a change in a code :
Dear Mr Fourie(Jnr)
We have received and processed the following claim(s):
Practice Name: DRS SACKS FERREIRA STANOJEVIC SUCH V (Practice No:399973) DIAGNOSTIC RADIOLOGY/NUCLEAR MEDICINE
| Service Date | Patient | Amount Claimed | Momentum Health Rate | Total To Be Paid | Pay To | Pay From
Major Medical | Pay From Savings | Pay From HealthSaver | Payment Run | Pay code*
2021/03/27 | Cara M | 7245.80 | 7245.80 | 0.00 | Supplier | 0.00 | 0.00 | 0.00 | 2021/10/29 | 90
*Pay code | Description
| 90 | The claim was not submitted within the 4-month period from date of service and is rejected as stale claim.
How on earth can this be since it was a pre-authorisation that was requested, approved and the communication failed between Momentum and the service deliverer ?
WHY should the patient fight for something that we trust our medical aid to sort out ?
This is not acceptable.
Please call me back urgently on ***.
Theo
After months of trying the 2 businesses to communicate to one another regarding an approved authorisation I receive the following feedback, as well as our calls requesting only a change in a code :
Dear Mr Fourie(Jnr)
We have received and processed the following claim(s):
Practice Name: DRS SACKS FERREIRA STANOJEVIC SUCH V (Practice No:399973) DIAGNOSTIC RADIOLOGY/NUCLEAR MEDICINE
| Service Date | Patient | Amount Claimed | Momentum Health Rate | Total To Be Paid | Pay To | Pay From
Major Medical | Pay From Savings | Pay From HealthSaver | Payment Run | Pay code*
2021/03/27 | Cara M | 7245.80 | 7245.80 | 0.00 | Supplier | 0.00 | 0.00 | 0.00 | 2021/10/29 | 90
*Pay code | Description
| 90 | The claim was not submitted within the 4-month period from date of service and is rejected as stale claim.
How on earth can this be since it was a pre-authorisation that was requested, approved and the communication failed between Momentum and the service deliverer ?
WHY should the patient fight for something that we trust our medical aid to sort out ?
This is not acceptable.
Please call me back urgently on ***.
Theo
CF
CornAA(C) Fourie's update28 Oct 2021, 08:14
Reviewer Update
Good morning Debbie
After months of trying the 2 businesses to communicate to one another regarding an approved authorisation I receive the following feedback, as well as our calls requesting only a change in a code :
Dear Mr Fourie(Jnr)
We have received and processed the following claim(s):
Practice Name: DRS SACKS FERREIRA STANOJEVIC SUCH V (Practice No:399973) DIAGNOSTIC RADIOLOGY/NUCLEAR MEDICINE
| Service Date | Patient | Amount Claimed | Momentum Health Rate | Total To Be Paid | Pay To | Pay From
Major Medical | Pay From Savings | Pay From HealthSaver | Payment Run | Pay code*
2021/03/27 | Cara M | 7245.80 | 7245.80 | 0.00 | Supplier | 0.00 | 0.00 | 0.00 | 2021/10/29 | 90
*Pay code | Description
| 90 | The claim was not submitted within the 4-month period from date of service and is rejected as stale claim.
How on earth can this be since it was a pre-authorisation that was requested, approved and the communication failed between Momentum and the service deliverer ?
WHY should the patient fight for something that we trust our medical aid to sort out ?
This is not acceptable.
Please call me back urgently on ***.
Theo
After months of trying the 2 businesses to communicate to one another regarding an approved authorisation I receive the following feedback, as well as our calls requesting only a change in a code :
Dear Mr Fourie(Jnr)
We have received and processed the following claim(s):
Practice Name: DRS SACKS FERREIRA STANOJEVIC SUCH V (Practice No:399973) DIAGNOSTIC RADIOLOGY/NUCLEAR MEDICINE
| Service Date | Patient | Amount Claimed | Momentum Health Rate | Total To Be Paid | Pay To | Pay From
Major Medical | Pay From Savings | Pay From HealthSaver | Payment Run | Pay code*
2021/03/27 | Cara M | 7245.80 | 7245.80 | 0.00 | Supplier | 0.00 | 0.00 | 0.00 | 2021/10/29 | 90
*Pay code | Description
| 90 | The claim was not submitted within the 4-month period from date of service and is rejected as stale claim.
How on earth can this be since it was a pre-authorisation that was requested, approved and the communication failed between Momentum and the service deliverer ?
WHY should the patient fight for something that we trust our medical aid to sort out ?
This is not acceptable.
Please call me back urgently on ***.
Theo
CF
CornAA(C) Fourie's updateReviewer Update
02 Nov 2021, 12:52Morning Debbie
Thank you for your call last week to confirm you are still investigating the matter.
I have once again received the following from Milpark Radiology indicating no change in the situation :
" Your account *** is 120+ days and has not yet been settled.
This has been handed over for collection.
Please contact us on *** "
This must be sorted before the end of this week.
Please make a decision, and then we will make ours.
Regards
Corné
Thank you for your call last week to confirm you are still investigating the matter.
I have once again received the following from Milpark Radiology indicating no change in the situation :
" Your account *** is 120+ days and has not yet been settled.
This has been handed over for collection.
Please contact us on *** "
This must be sorted before the end of this week.
Please make a decision, and then we will make ours.
Regards
Corné
CF
CornAA(C) Fourie's update02 Nov 2021, 12:52
Reviewer Update
Morning Debbie
Thank you for your call last week to confirm you are still investigating the matter.
I have once again received the following from Milpark Radiology indicating no change in the situation :
" Your account *** is 120+ days and has not yet been settled.
This has been handed over for collection.
Please contact us on *** "
This must be sorted before the end of this week.
Please make a decision, and then we will make ours.
Regards
Corné
Thank you for your call last week to confirm you are still investigating the matter.
I have once again received the following from Milpark Radiology indicating no change in the situation :
" Your account *** is 120+ days and has not yet been settled.
This has been handed over for collection.
Please contact us on *** "
This must be sorted before the end of this week.
Please make a decision, and then we will make ours.
Regards
Corné