1 reviews | Active since Jul 2016

26 Jun 2018, 09:56

Extremely Bad Service.

On the 05/06/18 I phoned the Transmed Medical aid Fund to check for PMB benefits for one of their patients. I spoke to an agent by the name of Noritha who told me that the member does have benefits for the given proceedure codes, she then gave me this ref number : ********** 58. On the 19/06/18 I called again because the claim was not paid for. I spoke to Kay who told me that the member has used up all of their benefits and that Noritha should have told me. I then explained to Kay that Noritha did not tell me that. Kay told me that they will escalate the call to their team leaders so that they can listen to their recording and they will call me back on the same day, I was given this reference no.: ********** 87. I then called back on the next day 20/06/2018 and spoke to Thember who told me that the call is still escalated to the team leaders. I then called again today on the 26/06/18 and spoke to Sheron who put me on hold because she was enquiring with their team leader, she asked to take down my details and I refused because they dont get back to me. I then spoke to Dimakatso who said she is the team leader, she then told me that she has not recieved any escalation regarding this call and she will listen to it today. My question to her was, how long does it take for a team leader to receive an escalation, she did not respond. She gave me this reference no. ********** 70.

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Replies (1)
Transmed
Transmed's reply29 Jun 2018, 13:36
Official

Dear Noshipho

Refer to the Hello Peter Complaint received 26.6.2018

  1. The complaint has been investigated and the following was noted:
  2. The provider was contacted by an agent on 26 June 2018 who requested a motivation to obtain authorization for the additional items to be registered on the member’s Care Plan.
  3. This information was received on 26 June 2018 and referred to the Authorization Department and approved.
  4. The claims for 6 June 2018 has been processed for payment on 29 June 2018.
  5. The practise was informed telephonically by the agent that the claim will be paid according to the Transmed benefits with our closing 29 June 2018.
  6. The necessary corrective action has been taken to ensure that this kind of problem can be prevented in future.

Kind regards

Best regards,