1 reviews | Active since Jul 2011
Refusal to pay full claim
Hi <br> <br> My wife is registered for the maternity program and we went for the first consultation and scan on 22/01/2015. The claim was submitted (R1200) and only R300 was paid out. I have called the call center to enquire why so little was paid for a scan and consultation and all I get told is that the wrong codes were used on the invoice. To begin I am not a medical professional but I can assure you that she was billed for a scan as well as a consultation (that is mentioned on the invoice). The maternity program clearly states that 2 scans and 12 consultations and now when we want to claim then we get told that the wrong codes were used. Secondly I would like to know if the doctor issues an amended invoice with the correct codes would this be acceptable?
In our member guide on page 37 it indicates all the codes that we cover for under the Maternity programme. We cover the 2 growth scans under the maternity programme. The scan that doctor performed was just a normal pelvic ultrasound.
Your wife would still require to have the growth scans during her pregnancy therefore it is best that you rather claim for these when it is required.
If you have any questions you are more than welcome to contact your Maternity Nurse that would be able to assist you through the pregnancy.
Kind regards
Yolandi Knoetze
In our member guide on page 37 it indicates all the codes that we cover for under the Maternity programme. We cover the 2 growth scans under the maternity programme. The scan that doctor performed was just a normal pelvic ultrasound.
Your wife would still require to have the growth scans during her pregnancy therefore it is best that you rather claim for these when it is required.
If you have any questions you are more than welcome to contact your Maternity Nurse that would be able to assist you through the pregnancy.
Kind regards
Yolandi Knoetze