1 reviews | Active since Sept 2016
SHOULD BE CALLED BOTTOM MED
<p>My son was rushed to hospital with a dislocated arm and badly bruised face after faling off the wall at my home, the Orthopedic iniatally pulled the dislocation back into place, placed it in a cast and said hopefully the wrist bones wont move but if it does we have to pin it. One week later I went back for xrays and on my way home the Doctor phoned to say we needed to pin the bones as they were moving, he woud get y son in on Tuesday. Monday the Specialist gets hold of TOPMED to get authorisation, they are are told by siwe they need a Injury Report, now this is 14:00 on Monday my son is going into Theatre on Tuesday. I arrange the injury Report and here is where TOPMED start back tracking, they say that because this is a PLANNED SURGERY, they will only pay for 3000.00 of the Orthopedic bill and only 1500 for the anathetist bill. When I asked if my son then fell again and hurt his arm and is rushed into casualty would they pay for all the bills then they reply YES. So where did I plan this surgery, If you think oh you should have taken gap cover I did with Mariele Goosen of Insuremed underwritten by Western Union Insurance what a laugh. I have a review on her and her company going up as well </p>
Dear Monique
As per the Council of Medical Scheme, emergency treatment is sudden or unexpected onset of a health condition/injury that requires immediate medical or surgical treatment, where failure to provide treatment would result in serious impairemant to bodily functions or serious dysfunction of a bodily organ or would place the persons life in serious jeopardy. Your son's surgery was not on the same day, but more than a week after the initial injury date, therefore it becomes an elective procedure where our DSP rules apply. The surgeon that performed your son's surgery is a non designated service provider, therefore the accounts will be paid at Scheme rates.
Kind regards,
Chanele Schoonraad
Dear Monique
As per the Council of Medical Scheme, emergency treatment is sudden or unexpected onset of a health condition/injury that requires immediate medical or surgical treatment, where failure to provide treatment would result in serious impairemant to bodily functions or serious dysfunction of a bodily organ or would place the persons life in serious jeopardy. Your son's surgery was not on the same day, but more than a week after the initial injury date, therefore it becomes an elective procedure where our DSP rules apply. The surgeon that performed your son's surgery is a non designated service provider, therefore the accounts will be paid at Scheme rates.
Kind regards,
Chanele Schoonraad
Not acceptable especially as my surgeon attempted to fix the problem with non surgical methods, your call centre knew from first thing on Monday morning and messed around the surgeons office until 2.00 in the afternoon when my son was being booked in for the following morning. This is not acceptable as a medical aid, you already ripped me off the first time, with his appendix, now you are trying to do it again because the surgeon then during an emergency appendectomy you claimed he used a different method to the one he got permission on.
I do not see this surgery as elective, or PLANNED as your call centre calls it, it was not a face lift to get rid of wrinkles, that is elective. Without the surgery he would have a handicapped hand for the rest of his life, Nor do I see the need to go to another orthopedic surgeon inUmhlanga and pay consultations all over again on your say so, when you were not paying for that either.
Not acceptable especially as my surgeon attempted to fix the problem with non surgical methods, your call centre knew from first thing on Monday morning and messed around the surgeons office until 2.00 in the afternoon when my son was being booked in for the following morning. This is not acceptable as a medical aid, you already ripped me off the first time, with his appendix, now you are trying to do it again because the surgeon then during an emergency appendectomy you claimed he used a different method to the one he got permission on.
I do not see this surgery as elective, or PLANNED as your call centre calls it, it was not a face lift to get rid of wrinkles, that is elective. Without the surgery he would have a handicapped hand for the rest of his life, Nor do I see the need to go to another orthopedic surgeon inUmhlanga and pay consultations all over again on your say so, when you were not paying for that either.
Dear Monique
I have emailed you directly regarding this query due to additional information that needed to be attached to an email.
Kind regards,
Chanele Schoonraad
Dear Monique
I have emailed you directly regarding this query due to additional information that needed to be attached to an email.
Kind regards,
Chanele Schoonraad