NW
Nischette W

1 reviews | Active since Nov 2015

20 Nov 2015, 07:52

No authorization received for hospitalization

Totally disgusted by the treatment received from Justin at TopMed medical aid. How can they say they do not authorize for testing to be done in hospital??? What then is the point of having medical aid/hospital plan if tests cannot be done, and these conditions are not stated in their policy schedule. They tell you to wait for 5 - 7 working days for authorization, even though you are in severe pain and can barely talk or walk, because they want to see if it's an existing condition before they authorize.After arguing with them they decide to have it within a day, and then when they find out that it's not an existing condition they decide they still won't authorize for a sonar, the medication the dr prescribed, and pain management. We waited from about 11.30 - 4.30pm without any pain meds. They gave the dr a terrible time and refused to authorize, even though she is the one who said I should be admitted in hospital. After the dr did the sonar she wanted to operate because of the severe pain and the size of the cyst, but she said she can't because Top Med said she is only authorized to operate if the cyst is twisted. They now treat you as an out patient and you are liable for the bills

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Replies (1)
TopMed Medical Scheme
TopMed Medical Scheme's reply20 Nov 2015, 09:58
Official
Hello NischetteW,

I have tried contacting you on the number you have provided but it went through to voicemail.

The non-disclosure procedure which was done is a standard procedure for all members that are admitted to hospital within a year of membership with a possible long standing illness or condition. We contacted your doctor to find out what treatment she has planned for your admission, as per your doctor, she wanted to administer pain medication and do a sonar, only if the sonar reflected a twisted cyst would she then take you to theatre. Please know that we did not advise your doctor that she can only take you to theatre if the cyst is twisted. We did advise her that if she needs to take you to theatre for the twisted cyst we will then grant your authorisation, but we cannot approve your authorisation for investigative purposes only. This is available in our Scheme rules.

Kind Regards,
Chanele Schoonraad