dD
dmoumakwe D

1 reviews | Active since Jul 2016

18 May 2018, 13:14

worst service ever....

I called the medical aid on the 14th of May 2018 with regards to an inquiry about my hip replacement procedure that i need to have done on the 21 May 2018. I explained to them that due to my medical history with the condition i have and i have been consulting with DR JF Van Staden with regards to this problem. He is the doctor that i have been attending since 11/11/2014. I explained to them that i cannot just switch and move to another Dr just because he is not on their list of network doctors. The doctor explained to me that the medical aid always pays the patients instead of the practice so he needs confirmation that the medical aid will pay him and not me. I called the medical aid and i spoke to Sanvier and Adriaan and i explained my situation, i was advised that if i as the owner of the medical aid can make the request in writing and request the medical aid to pay the claims directly to the doctor and not me. I did send the email along with the quotation they asked for. Today on the 18 May 2018. I called the medical aid in the morning requesting the letter to be send through to me as i still haven't received it. I spoke to Adriaan again today and he told me my email had been send to the claims department for the letter to be send to me. I received an email that only talks about the quotation and that they will pay the claim but nowhere does it state that they will pay to the doctor. I called again and spoke to Andria if im not mistaken and she also confirmed to me that the email Adriaan send this morning is still to be processed but it will be send as per my request for them to state the payment will be made to the practice. Now when i call again I spoke to another agent who now tells me that they will not send me such a letter to confirm they will make payment to the doctor because the doctor is charging above medical aid rates, i then spoke to the manager who confirms the same statement that will not pay the doctor. I now want to understand what do i do now with all the wrong information provided to me all this time, because had i known from the 1st day when i called making this request, i would have cancelled the date for the procedure until such time where i have managed to come up with the money for the doctor, because the doctor will not do the procedure due to this problem that the medical aid has of paying the clients and not him. I am sitting with a serious crisis and yet i'm suffering from the pain from this Hip that needs to be operated. how is any of this fair on me when i have been paying medical aid knowing very well i would need to go for this surgery and now when the time comes i have to suffer even more. When the company told us that they would move us From Metropolitan to Momentum health they send us for medical aid expo where the sales consultants selling this medical aid would advise us correctly on which options to take. I specifically told the agent about my existing condition and how my then medical was covering all the doctors and all hospitals with no restrictions and that they need to advise on which of the plans at momentum would give me the same benefits and they advised me to take this incentive plan. Now today 2 days before my admission i'm faced with all these inconveniencing things. This is really unfair.

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Replies (1)
Momentum Health
Momentum Health's reply18 May 2018, 13:51
Official

Good day Msdee-joan

Thank you for bringing this enquiry to our attention, one of our agent will contact you shortly to discuss .

Kind regards

Jody Saunders