PD
Patricia D

1 reviews | Active since Jan 2012

09 Dec 2015, 15:04

SPECTRAMEDS APPALLING, DISGUSTING PAYMENT SCHEDULE

12.08.15 admitted to Flora Clinic with a stroke. Dr. ordered a CAT scan.SPECTRAMED, refused to pay. My son paid. SPECTRAMED refused to pay for Drs. Path. Labs. etc. I handed everything to CURA ADMIN. For R180/month they saved me R8000. They sent me the following:- The below ICD10 code is a PMB condition & needs to be referred back to the client's medical scheme, attached please see the script from the council for medical schemes in this regard, once we received a reason from the medical scheme as to why the claim was not paid in full as prescribed by legislation, Hollard will reconsider the member's claim, Cura cannot obtain a reason from the scheme. I resubmitted the claims to SPECTRAMED & by return received this:- listing claims as Submitted for PMB Reprocessing to be paid 20.11.15. With SPECTRAMED, it's just disaster after disaster. I requested proof of payment & was told now payments will only be made on 18.12.15! NOW, let me put this to you, do you really think, or believe, that when viewing their accounts at the end of the month SPECTRAMED would say to themselves 'Deary me, a mistake on Mrs Duncan's account, we must rectify this & pay her immediately'. I THINK NOT!

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Replies (1)
Spectramed Medical Scheme
Spectramed Medical Scheme's reply09 Dec 2015, 15:57
Official
Hello Pat Duncan,

Thank you for bringing your concerns to our attention. Agility Global Health Solutions Africa, administrator for Spectramed, is committed to providing only the best service to our valued members. We would like to extend our sincere apologies if you feel that we have fallen short of this promise. A dedicated consultant has been assigned to your query and he/she will be in touch soonest to discuss your concern in further detail.

Kind regards
Agility Global Health Solutions Africa on behalf of Spectramed