MP
MPHO P

1 reviews | Active since Feb 2013

03 Jan 2022, 08:58

Incompetence

I received an SMS from Netcare Medical scheme some time in December to say I owe R200 and odd cents. I was shocked to hear that I owe them because my premiums are debited directly for my pay slip so I phoned them immediately and the guy I spoke to could not answer instead he said he will get back to me which he never did. 2 weeks after the SMS I received a phone call to say I owe them, when I asked how come I was told it was for a claim in September which was paid from risk benefits because ''I did not have fuds'' from what I know I had fuds . Usually if you don't have funds medical aid rejects the claim right there and there and you know as member that if funds are depleted you need to pay for the claim. It is not my fault that they chose to pay from Risk benefits and notify me 3 months later. I am not going to pay that amount, they should have simply rejected the claim so I have to suffer because someone did not do their job. I refuse.

0
Replies (3)
Netcare Medical Scheme
Netcare Medical Scheme's reply03 Jan 2022, 11:12
Official
Dear Mpho We have been in touch to help with your query. We’ll contact you with further feedback as soon as possible. 
 
Regards Netcare Medical Scheme 
MP
MPHO P's update09 Feb 2022, 14:08
Reviewer Update
Again Netcare Medical aid phoned me for their incompetence. I have stated previously that I will not pay for the claim that they decided to pay from my risk benefits instead of rejecting the claim due to no funds. I have given them 2 options to either reverse the claim and I will pay the pharmacy or deduct their money from my savings and someone was suppose to get back to me and to date I am still waiting. Instead of getting proper feedback I am told the amount is still outstanding and that the amount is not going anywhere.
Netcare Medical Scheme
Netcare Medical Scheme's reply10 Feb 2022, 13:11
Official
Dear Mpho We have been in touch to resolve your query. 
  
 Regards Netcare Medical Scheme