Unhappy client

I have been a member of Momentum Health since 1 November 2014, without fail my contributions are paid monthly and on time. Only this year I required attentive medical care due to my pregnancy.

To say the least, it hasn’t been easy dealing with Momentum Health. My biggest issue currently is the blood tests my gynaecologists sent me for that Momentum Health refuses to pay because the gynaecologists is not on the network.

What I’m struggling to understand is according to their pathology codes; all the tests ran are payable by my option expect for the 2 most expensive ones but Momentum health still will not pay because my gynaecologists is not on the network, this was after Momentum Health told me, Lancet Labs had not completed the referring doctor on the claim.

With the above being said, I don’t understand how I could’ve seen my gynaecologists and when she sends me for bloods, left the consulting room, to go look for a GP on the network just so Momentum Health can pay- it just sounds tedious!

The above ware initially the two reasons for the declined claim, when I questioned it, I was later provided with the reason that bloods are not part of the maternity programme. I am pregnant, the gynaecologist sends me for; thyrotropin / free thyroxine , progesterone, full blood count, platelet count, rhesus d antigen, A,B,O antigens, rubella IGG – serum, rubella IGM – serum, syphilis screen, HEP B surface antigen and HIV I & 2 elisa (abbott)- How is this not part of the maternity programme?

Yes, it may not be part of the programme but on the bases of the referring doctor not being on the network even though she is my prenatal care specialist really makes no sense, especially for the tests on the Momentum Health’s pathology applicable codes.

Also, I have to resubmit the claim all the time after my prenatal visits because it’s always declined first due to me not having enough savings but Momentum Health claims from my savings instead of the major benefit- I’ve been advised that “it is a development issue and cannot be resolved” given my existing pre authorization that the Doctor submits all the time with the claim.