AK
Adele K

1 reviews | Active since Jun 2016

22 Jun 2016, 07:37

Maternity Claims NOT Paid

<p>I registered for the "Our Baby" Programme, which I did. Only 6 Consultations are covered, and two scans - and only a limited amount per claim - which I understand and accept. My first claim was submitted on the 14th of May, and after a month, the claim was paid from my Savings, not the Maternity Benefit - which was incorrect. Immediately after that, I contacted Topmed to correct the mistake, which is still not done. They need to reverse the payment they made to us, and refund the Savings account, and then pay me back from the maternity benefit. I've explained this over and over and over and over again.</p> <p>I've subsequently submitted a second claim, which is also not yet paid from the Maternity Benefit. I've had a response from Topmed saying the Doctor's invoice is incorrect, it shows an invalid ICD10 code, which it doesn't, it's clearly shown under the "KODE" column on the invoice. I've brought that under Topmed's attention, yet, I'm still no further than day one. </p> <p>I was told that I may use any provider, and that I can claim back, but I will only be paid as per my benefit schedule, and I accepted that, however, Topmed is not keeping their end of the bargain, they are not paying me from the maternity benefit, which I specifiically registered for in time, now I'm not getting any benefit out of it. I am not getting answers, I've called numerous times, I've sent numerous emails, and I'm still no further. When is Topmed going to sort this out? </p>

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Replies (2)
TopMed Medical Scheme
TopMed Medical Scheme's reply22 Jun 2016, 08:31
Official

Dear Adele

As per our telephonic discussion, your claims have been corrected and paid from your maternity benefits, our maternity nurse has added the ICD10 which is being used by your doctor, therefore going forward you will not experience the same delays.

Kind regards,

Chanele Schoonraad

AK
Adele K's update22 Jun 2016, 10:12
Reviewer Update

Thanks Chanele - I'm delighted to know this is now sorted out as per our agreement.

Regards,

Adele