Late mother's account not paid

<p>This is part of my email communications with Topmed regarding my late mothers' medical claim and +-the last mail from Topmed in this regard.</p> <p> </p> <p>22 March</p> <p>Topmed,</p> <p>Refer to the mail below, which was forwarded to me by my sister-in-law (Retha Erasmus), the attachments and various other mails and phone calls.</p> <p>The mail below indicates that certain payments would be made by 10 March – what payments were made by that date?</p> <p> </p> <p>I want to bring the following to your attention – much of this you can verify with your own records.</p> <p>1. My mother was in the hospital on 7, 8, 9 and 10 June 2015</p> <p>2. At least the hospital account in dispute was sent to you, as I understand by the hospital, shortly after 10 June 2015</p> <p>3. On 9 Aug 2015 (or near to that date) my sister-in-law spoke to Dee and she said that all the accounts would be paid – I therefor accept that you already received all three accounts by that date</p> <p>4. My mother passed away on 18 Aug 2015 - at that stage I was overseas</p> <p>5. A note was made on the account of 29 Jul 2015 received from Dr Dercksen and Ass that the account was again submitted to you on 29 Aug 2015</p> <p>6. I returned back from overseas on 11 Sept 2015</p> <p>7. On 15 Sept 2015 (that date was confirmed to me by Lee-Ann de Jager as being on your system) my sister-in-law contacted you to speak about the accounts – but, because she is not the executor, she was told that nothing could be discussed with her</p> <p>8. I submitted my application to be appointed as executor to the Master on 13 Oct 2015</p> <p>9. My first call to you was on 4 Nov 2015. I spoke to Daffie – but as I was not appointed as executor at that stage, nothing could be discussed with me</p> <p>10. The Letter of Authority was issued by the Master on 24 Nov 2015 and I only received it on 14 December 2015 – a day before our offices closed for the Dec holidays</p> <p>11. On 4 Jan 2016 I had a call to you – ref 699878 – in which I was notified that the days which my mother was in hospital, had not all been approved – and that the hospital had to request an approval for the whole time – which was afterwards done</p> <p>12. I cannot understand why, at that stage, no mention was made about the “stale” problem</p> <p>13. On 22 Jan I spoke to Ayanda(?) – ref 717652</p> <p>14. After that I had a number of calls regarding the non-payment of the three accounts – ref 717652</p> <p>15. On 15 February I was told that a brain report was requested – ref 717652 – I don’t know why a brain report</p> <p>16. Now I received the mails informing me that the claims are stale and referring to the 4 months and further 60 days period</p> <p> </p> <p>If you look at the above, you will surely agree that there was communication from our side with you the whole time since my mother was hospitalized – and now we get the notice that the claims are stale.</p> <p> </p> <p>We request you to reconsider your decision not to pay the three accounts.</p> <p>H Erasmus</p> <p> </p> <p>Then from Topmed</p> <p>Subject: Topmed Medical Scheme: MRS AFRA ERASMUS (EST LATE) ( ********** )</p> <p> </p> <p>Dear Mr Erasmus</p> <p> </p> <p>With regards to our conversation last week, the hospital account for your late mother has been reviewed again, unfortunately the account was still declined due to the account being older than 4 months. I have looked through all the records to determine when we received any communication from the hospital or third party. The only communication that we received was on 12/10/2015, this was a duplicate email that was sent to us previously with no new information. On the 24th of December 2015, we received an email from you with the executor documents attached, the last communication from the hospital was on the 8th of January 2016 were we received an updated email with new information, however this after 7 months from the admission with no other follow ups.</p> <p> </p> <p>Kind Regards,</p> <p> </p> <p>Chanele Schoonraad</p> <p>Team Leader – Call Centre </p> <p>Private Health Administrators</p> <p> </p> <p>I am not happy in how Topmed has handled this matter.</p> <p>The main reason for not paying the accounts in question, looks to be that I/we did not contact Topmed within the four months' period - looking at the above (in your mail none of my dates in 3,5 and 7 above are disputed by Topmed) we did contact Topmed but as, at that stage, I was not appointed as executor yet, Topmed did not want to speak to me/anybody regarding this - how could I then in any case have met the 4 months' time limit?</p> <p>After the above mails I also phoned Topmed a number of times and every time left a message for Chanele to phone me back - but no call was returned.</p> <p>I again ask you to reconsider your decision.</p> <p>Hermann Erasmus - Executor</p>