1 reviews | Active since Mar 2016
Misleading hospital benefits and unreasonable wait
I was a topmed member in 2015. I had my child at Femina in september. They say it is a network hospital so I did not expect to have any bills from anyone. In october I started receiving accounts from the anesthesiologists for my planned natural and emergency c-section. I contacted topmed and they told me they charged more than the scheme tarrif. What is quite disturbing is that they say it is a network hospital so i don't understand why anyone working in those hospitals would overcharge. Hospital/doctor charges should be upfront and agreed before the scheme agrees to have them in their network. It makes no logical sense for the customer otherwise. I am now left with an outstanding bill and i don't expect to have outstanding bills for such large amounts after I have been paying a Medical AID every month. I then cancel the medical aid out of anger and ask to rejoin, for which I was given a 3 month waiting period???? I was with you this whole time and now you tell me about a 3 month waiting period?????
We do have agreed amounts with the hospitals, but those agreements do not include the doctors providing a service to a member during their stay at the facility. We do have a list of designated service providers that charges Schemes rates and are available to members on request.
Due to your ceasearian being a emergency procedure, the account has been approved for PMB payment (Prescribed Minimum Benefits) and has been reprocessed for full payment.
With regards to your 3 month general waiting period, this has been placed correctly. If a member was a medical scheme for more than 2 years with a break of less than 90 days, the medical scheme they are joining can place a 3 month general waiting period, but they cannot exclude PMB treatment.
We sincerely apologise for the inconvenience caused with this matter.
Kind regards,
Chanele Schoonraad
We do have agreed amounts with the hospitals, but those agreements do not include the doctors providing a service to a member during their stay at the facility. We do have a list of designated service providers that charges Schemes rates and are available to members on request.
Due to your ceasearian being a emergency procedure, the account has been approved for PMB payment (Prescribed Minimum Benefits) and has been reprocessed for full payment.
With regards to your 3 month general waiting period, this has been placed correctly. If a member was a medical scheme for more than 2 years with a break of less than 90 days, the medical scheme they are joining can place a 3 month general waiting period, but they cannot exclude PMB treatment.
We sincerely apologise for the inconvenience caused with this matter.
Kind regards,
Chanele Schoonraad