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Beulah B

1 reviews | Active since Mar 2009

08 Jun 2016, 06:08

Momentum refused to pay for pre authorised op

<p>In July of 2015 I had my gall bladder removed via the emergency room in an emergency operation. We obtained a pre-auth number and authorisation from the medical aid. Months after, I received a bill from netcare for a coaulating sheer used DURING the operation (R6271). I had to pay immediately or netcare would black list me. I logged a call with with Momentum but they refused to pay for it as this is a reusable item. I generally need to pay in when I have things done but it is UNREASONABLE to expect me to prevent a surgeon in mid operation to use a shear. I am on the most comprehensive cover and I am petrified to be in an accident as I dont know what fine print momentum will hide behind to refuse payment.</p>

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Replies (6)
Momentum (SA)
Momentum (SA)'s reply08 Jun 2016, 06:34
Official

Thank you for bringing this to our attention.

A consultant will contact you shortly to discuss the matter and resolve the query.

Kind Regards

Debbie van der Haar

Momentum (SA)
Momentum (SA)'s reply08 Jun 2016, 12:22
Official
Dear Ms Mpini, Please be advised that a member of our Funds@work staff will be calling you shortly to explain our process and turnaround times. As you ended your employment at the end of May, we can only start to process your claim once your employer has done a reconciliation and the contributions have vested. This will only occur after the 7th of the month. The turnaround time then is approximately 26 working days to process the claim. Kind regards, Nicolette D'Arch
Momentum (SA)
Momentum (SA)'s reply08 Jun 2016, 12:25
Official
I apologize for the posting above - it was placed in error on your posting for another client. Please accept my apology in this regard. I will provide you with feedback on your posting shortly. Kind regards, Nicolette D'Arch
Momentum (SA)
Momentum (SA)'s reply08 Jun 2016, 12:44
Official
Dear Ms Botha, please be advised that this is a closed scheme which is administered by South African Breweries. Although the scheme is underwritten by Momentum Medical Scheme Administrators, actual payment is processed by South African Breweries and not Momentum. Unfortunately no staff member in Momentum or our Momentum Health division has access to your claim or any details thereof. You will need to contact South African Breweries directly for information on your complaint. We will therefore be requesting that the Hellopeter Administrators switch your complaint from Momentum to South African Breweries. Kind regards, Nicolette D'Arch
BB
Beulah B's update08 Jun 2016, 13:29
Reviewer Update

Do NOT change the complaint to SAB. Your incompetence is frustrating. Should you do that I will escalate this exponentially.

Momentum (SA)
Momentum (SA)'s reply08 Jun 2016, 14:06
Official
Dear Ms Botha, I am sorry - but this scheme is not administered by Momentum directly. Unfortunately Momentum and Momentum Health are not able to assist you and resolve this complaint as the scheme you are on is administered by the South African Breweries Medical Aid Society. Momentum is not involved in any way in the payments of your claims. I am so sorry that I am unable to assist you further. I can however provide you with contact details of the correct administrator - you can contact Dewald van Jaarsveld at ***.