KM
Khanyisile M

1 reviews | Active since Sept 2018

06 Sept 2018, 10:05

Delayed pre-auth and treated like some ********

I was referred to a gynecologist by my GP because of pain in my abdomen & painful periods. Went to see one and she said I needed to have a laparoscopy to remove a cyst that she had discovered. She booked me for the procedure, then the day before the procedure the doctor said she was waiting for authorization from topmed. The doctor had filled in the medical form she was asked to. I called them around 2pm as they had not gotten back to me or the doctors rooms. Spoke to a lady who was rude and had no interest in making me understand what was going on. Instead she referred me to my broker. What nonsense!!??? She told me there was no authorization as I had joined the medical aid this year and they needed to do investigations for pre- existing medical conditions. Mind you, she didn’t tell me this I had to dig it out of her because I work in the insurance industry and have some understanding of pre-existing medical conditions. Had I not called wh m would she have told me this ? I had made arrangements for the procedure. She didn’t even call the doctors to tell them what the conclusion was. The doctors had to keep calling her.

Fair enough, they want to make sure, but why will it take 7-14 working days ? And where are they going to get the required information because they didn’t ask for any of my doctors detail ???? I have never claimed for anything on any medical aid other than gp visits. The only procedure I had was not with them and I was a dependent on the medical aid and I disclosed the procedure.

That consultant treated me like I was some ******** who was being investigated which really infuriated me . To think I was in the process of canceling the medical aid my partner is on to add him and the children onto topmed.

What if I had to be admitted in an emergency? Would I have been told to wait 7-14 working days ???

I am soooooooooooo DISAPPOINTED!!!!!!

0
Replies (2)
TopMed Medical Scheme
TopMed Medical Scheme's reply06 Sept 2018, 10:56
Official

Dear misskhanyi

Thank you for taking the time to comment on your interaction with the Scheme.

As discussed telephonically today, we will investigate the matter with urgency and provide you with the necessary feedback on your enquiry.

Kind Regards

Joanine Knoetze

Topmed Medical Scheme

KM
Khanyisile M's update28 Sept 2018, 14:50
Reviewer Update
3 weeks later and my complaint hasn't been sorted out. I was told the investigators needed to investigate if I didn't have the condition prior to taking out the medical aid. I called and email Llewellyn Hondett who was supposed to investigate and get this information,but never got any call back or response to my emails. I finally emailed Joanine, then he called and said he was struggling to through to the doctor. Then on the 11th he sends a form for the gp to fill in. I took the form to the gp and sent it back to him on the 12th. Never got an Acknowledgement of receipt or anything. Tried calling and emailing for days and he was never available nor did I get a call back. I called Joanine 10 day later on day 14 that they said the query would be solved by and Llewellyn said the information was not enough and they needed information from my doctor before that. He sat on that for 10 days. I gave him the doctors contact detailes , and again he went MIA. I CALLED ON 25/09/2018 and he said he was not able to get through the doctor. I took the form and took time off work to get it filled in. I sent it back to him first thin this morning and still nothing. No acknowledgment of receipt ,nothing. I called 4 times and he was not available. The 3rd time they said I should call back in 10 minutes as he is on a call, I called back after 10 minutes and was told he wasn't at work. I asked for Joanine, they said she'd be available after 10 minutes, when I called, they said she was on lunch and would be back after 45 minutes. SO I'M BEING MADE A FOOL OF BY TOPMED SND ITS STAFF. I HAVE NO IDEA WHY I AM BEING TREATED THIS WAS BY TOPMED. I HAVE DONE ALL OF LLEWELYN'S WORK FOR HIM WHILE HE IS ALWAYS ON LUNCH. I REGRET THE DAY I JOINED THIS MEDICAL AID.