Horrible track record of payments causing severe stress on patients.

I am leaving this review on behalf of my dad who has had the most emotionally and mentally exhausting experience with Pathcare since June 2020 while he was hospitalised due to a stroke and Covid-19. The problems originated with Mitchell's Plain Melomed where it is presumed a specialist submitted incorrect codes for in-hospital pathology tests that were done while my dad was hospitalised for almost two weeks. This resulted in PathCare claims being rejected and a bill amounting to around R21000. Since my dad had a stroke, he was unable to directly deal with the emails sent to him from PathCare demanding payment. It was only until much later and just before my dad was readmitted to Gatesville melomed that I was constantly on the phone with PathCare accounts department, Melomed and Samwumed to establish why those claims where rejected. I requested PathCare to find out which claims were rejected and why but they refused to do so and said the onus was on the patient to find out why. I did so on my dad's behalf and discovered the doctor treating my dad filled in incorrect codes on the invoice or something like that. Nevertheless, samwumed committed to contacting the doctor and had him do the correct code submission and then they reworked the PathCare account to have the claims settled, but somehow there was always an issue around dates for the 5/6/2020 and 7/5/2020 where PathCare continuously claimed that the claims were short paid. I was on the phone with Samwumed again and myself and the contact centre agent pinpointed the so called short paid claims but the agent made it clear that both claims were paid on dates in October 2020, and then I forget the other date. I had to contact Pathcare yet again and finally became so annoyed after my patience had run out and requested a manager or some other superior have a look at the account. Eventually they put me in contact with someone in MedicAid, and the lady said the account was not reconciled and they located the error and then a new statement came with the so called short paid claims of the dates in question. Another call to Samwumed assured me the claims were paid for in full and the agent said Pathcare must not be reconciling their accounts correctly. She insisted that Pathcare call Samwumed or email them with the exact invoice in question and I doubt this happened as my dad was forced to pay the now lowered amount in full. The it became apparent that someone supposedly paid a bill in the amount around R1000. It wasn't the medical aid and I know for sure it wasn't my dad but a Pathcare accounts assistant said someone made that payment and he sent me the copy of the statement to see where that payment was on the statement. Nobody has access to my dad's account to be able to make that payment and what I further learned is that his Pathcare account went into credit because of the payments he made when being threatened by Pathcare lawyers that they would take legal action. I asked Pathcare about this and they said if my dad overpaid, they would always just put that credit on his account so future Pathcare bills would be deducted from that. So nobody admits that Pathcare unnecessarily billed my dad.

Today my dad received another Statement from Pathcare similar to the other 3 he received to make immediate payment for numerous tests. There wasn't even a claim submitted for these tests! Samwumed didn't receive any claims either as I called them to verify, but a Pathcare account consultant tells me this is the norm to sent these statements of payments to be made to notify the patient but I have never seen such other than when a claim has been rejected and needed to be resubmitted or when Pathcare insists they have not been paid yet by the medical aid. So in this case Pathcare jumped the gun demanding payment without them having submitted any claims.

I am thoroughly fed up for the undue stress Pathcare is causing my dad and our family. I have dealt with a range of Pathcare consultants and most just shove the blame in my dad's direction not even attempting to locate any error on their end. I have dealt telephonically with some of the most insensitive consultants that had an attitude that they want the money paid regardless of what the problem may be. I have had to listen to consultants tell me that they don't want to directly deal with Samwumed. There was a total of two of the many consultants I have spoken that were willing to reach out to a different department to locate the potential error.

Can't you just commit to decent and efficient service from the beginning? Why must sick patients be burdened with account errors? Do you even realize that the stress you cause impacts patient health even more?

My dad hates unsettled bills, but he is sufficiently covered via his medical aid for the services that was rendered, but the errors made by other parties really put him in very unnecessary and costly situation because he also had to run a phone bill to work to get some of the issues resolved between Pathcare and Samwumed where Pathcare was supposed to take that responsibility in submitting the mysterious invoices they claimed weren't paid and then following up to see if those payments were reconciled.

This is a stress that I hope comes to an end, or we would just have to go with other pathologists if this continues.