LH
Laulani H

1 reviews | Active since Aug 2012

21 May 2015, 16:34

Late Authorization

I went to the emergency room on Monday 18/05/2015 with stomach and chest pains. I was sent home with medication. When I still didn't feel any better on Tuesday I contacted my GP and she advised that I be booked into hospital for pain and tests to specify what the problem is. I phoned Topmed on Wednesday 20/05/2015 09h00am to get authorization. They told me my doctor needs to fill out non declaration forms in, to verify that this is not an existing problem that I did not tell them about. It took them a day to send the documentation. Today Thursday 21/05/2015 at 10h35, 24 hours later, the forms was received by my GP. It was sent back at 12h40. I am in a lot of pain and don't know what they problem is except that it is in my abdomen. They won't tell me when they will be finished with the non declaration or when I will be able to go to hospital. Everyone gives a different answer and when I ask to speak to a supervisor, then I was told she is off sick. I have been phoning every hour to find out how far everything is. This is not right. I am in pain and cannot go to a doctor for my stomach until they are finished and take their time. I have to wait another day for an answer.

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Replies (1)
TopMed Medical Scheme
TopMed Medical Scheme's reply22 May 2015, 08:28
Official
Hello LaulaniH,

When signing your application for you indicate to the Scheme whether you are having any symptoms that you would seek treatment for in the next 12 months.

You joined the Scheme on the 01/01/2015 and requested for admission on the 20/05/2015. It is a standard process to verify that this condition was not pre-existing before joining the Scheme. You also have exclusions for pre-exisiting conditions so we need to verify and ensure that this admission does not relate to the exclusion already in place.

We received the necessary forms from your treating doctor later yesterday afternoon and our underwriting department is reviewing your request.

Feedback will be provided to you shortly.

Kind regards
Yolandi Knoetze