********** Medical Aid

This Medical is a bunch of ******, I had to get my tonsils removed and I had a deviated septum my surgery was scheduled for the 28th of March 2019. So I contacted the Medical for the authorizations and to find out if they cover for the following procedures. Everything was approved and got the surgery done and 2days later i was rushed to the emergency room again as i was bleeding and the on call E.N.T had to close up a blood clot and i was admitted again for 1 day stay. A week later I received all these bills, the anaesthetists wasn't covered they didn't pay a cent to him. The E.N.T was not paid was not paid in full. They didn't pay the on call E.N.T on call in the emergency room. I think this needs to be taken further as i feel this is ***** on motohealth side.

Authorisation details

Authorisation number

********** 36

Date of admission

29 March 2019

Approved length of stay

1.0 days

Hospital / Facility

Vincent Pallotti Hospital

Diagnosis code / ICD 10 code

J34.2, J34.8, J35.1

Procedure code / CPT

30130, 30520, 30802, 31255, 42804

Tariff / RPL

1022, 1029, 1030, 1036, 1052, 1101

Applicable limits

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Overall annual limit

R 519100 per family per annum

Co-payments

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We are pleased to confirm that Vincent Pallotti Hospital is a recommended network facility on your selected benefit option. Your hospital account should be covered in full.

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Please note that once the overall annual limit and specific benefit sub limits on your option are depleted, this option is PMB exempt.

Doctors reimbur*****t

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Are you aware that using the OneCare Network Specialists, including anaesthetists, provides you with peace of mind that your doctor will claim at Scheme rates? This will protect you from unexpected shortfalls, regardless of whether your admission is related to a Prescribed Minimum Benefit condition.

To find OneCare Network Specialist in your area, please contact the call center on ***.

Additional information

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Limit advised at time of authorisation is subject to outstanding claims being processed.

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Take-home medication (TTO's) limited to 7 day supply only.