LK
Lyle K
1 reviews | Active since Oct 2014
18 Feb 2015, 10:16
Motivational letter for code not covered by scheme
I went for four procedures in one surgery. Two of the codes were not covered and i was told to get a Motivational letter written by the Specialist. I was not told or educated that the letter does not guarentee that the codes will be covered,this I only found out after the procedure was done and in my recovery had to now stress with sitting with this huge bills. I refuse to take responsibilty for this miscommunication or misunderstanding TopMed must take some responsibilty. I have called and emailed but no solutions are offered only back and forth emails.
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TopMed Medical Scheme's replyOfficial
18 Feb 2015, 10:27Hello Jihaad2014,
According to our records the 5 contacts made with our Pre-authorisation department indicated that the 2 of the 4 procedures are excluded as per your benefit options.
Our walk-in centre indicated a motivational letter can be sent and it will be reviewed by our Clinical team. Providing a montivational letter does not guarantee approval of the procedure. Our clinical has not yet provided you with feedback before you proceeded with the actual procedure. Hence authorisation was only given for the 2 procedures authorised initially. We have contacted you once we had feedback from our Clinical review team and was informed that your wife proceeded with the treatment without the necessary approval.
Kind regards
Yolandi Knoetze
According to our records the 5 contacts made with our Pre-authorisation department indicated that the 2 of the 4 procedures are excluded as per your benefit options.
Our walk-in centre indicated a motivational letter can be sent and it will be reviewed by our Clinical team. Providing a montivational letter does not guarantee approval of the procedure. Our clinical has not yet provided you with feedback before you proceeded with the actual procedure. Hence authorisation was only given for the 2 procedures authorised initially. We have contacted you once we had feedback from our Clinical review team and was informed that your wife proceeded with the treatment without the necessary approval.
Kind regards
Yolandi Knoetze
TopMed Medical Scheme's reply18 Feb 2015, 10:27
Official
Hello Jihaad2014,
According to our records the 5 contacts made with our Pre-authorisation department indicated that the 2 of the 4 procedures are excluded as per your benefit options.
Our walk-in centre indicated a motivational letter can be sent and it will be reviewed by our Clinical team. Providing a montivational letter does not guarantee approval of the procedure. Our clinical has not yet provided you with feedback before you proceeded with the actual procedure. Hence authorisation was only given for the 2 procedures authorised initially. We have contacted you once we had feedback from our Clinical review team and was informed that your wife proceeded with the treatment without the necessary approval.
Kind regards
Yolandi Knoetze
According to our records the 5 contacts made with our Pre-authorisation department indicated that the 2 of the 4 procedures are excluded as per your benefit options.
Our walk-in centre indicated a motivational letter can be sent and it will be reviewed by our Clinical team. Providing a montivational letter does not guarantee approval of the procedure. Our clinical has not yet provided you with feedback before you proceeded with the actual procedure. Hence authorisation was only given for the 2 procedures authorised initially. We have contacted you once we had feedback from our Clinical review team and was informed that your wife proceeded with the treatment without the necessary approval.
Kind regards
Yolandi Knoetze