PT
PETRO T

1 reviews | Active since Nov 2016

15 Nov 2016, 17:02

FATHER NEEDS URGENT HIP REPLACEMENT BUT TRANSMED REFUSES

<p>MY FATHER PAYS R6625.00 PER MONTH FOR HIS MEDICAL AID TRANSMED.</p> <p>NOW THAT HE NEEDS AN URGENT HIP REPLACEMENT THEY DECLINE AUTHORISATION, THEY SAY IT IS NOT LIFE THREATENING. WE WENT TO THE DR AND THEN FOR A SECOND OPINION BOTH SAID MY FATHER WILL END UP IN A WHEELCHAIR IF HE DO NOT RECEIVE THIS OPERATION. TRANSMED JUST DONT CARE ABOUT THAT, OTHERWISE THEY WOULD HAVE GIVEN AUTHORISATION AS WE HAVE SENT THEM THE MOTIVATION FROM THE ORTHOPAEDIC AS THEY REQUESTED WHEN THEY FIRST SAID IT MIGHT BE DECLINED UNLESS WE SENT A MOTIVATION. ON 14/11/2016 THEY SAID THEY DECLINE BUT WE CAN SEND AN EMAIL THEN THE MEDICAL BOARD WILL HAVE A LOOK AND DECIDE, THE EMAIL WAS SENT ON 14/11/2016, ON 15/11/2016 I PHONED TRANSMED ON ***, AND THEY SAID THE EMAIL WAS RECIEVED AND IS AT THE BOARD AS WE SPEAK I MUST PHONE BACK AGAIN ON 16/11/2016, THEN THE BOARD WOULD HAVE DECIDED. BUT MY FATHER PHONED ON 15/11/2016 ALSO TRYING TO FIND OUT WHAT TO DO, SO HE CAN GET THIS MUCH NEEDED OPERATION, AND THEY INFORMED HIM THAT THIS OPERATION WAS ALREADY DECLINED ON 14/11/2016. WHY AREN'T THIS MEDICAL AID NOT TELLING THE TRUTH? IS IT A MATTER OF MONEY COUNTS BUT THEIR MEMBERS DON'T? I AM DEEPLY DISAPPOINTED THEIR HANDLING OF THIS SENSITIVE CASE. </p>

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Replies (1)
Transmed
Transmed's reply17 Nov 2016, 14:15
Official

Dear Petro

Your complaint received was investigated and the following feedback;

Due to the financial status of the Private Network plan and benefit utilisation the Fund was forced to make certain benefit changes in 2012 to continue providing the plan to the members with private hospital access. This plan selected by your father only cover Prescribed Minimum Benefits (PMB) treatment/procedures as Major Medical

The initial request for pre-authorisation for the condition M16.1- Other primary coxarthrosis was denied. The appeal was referred to the Medical Advisory panel for review and declined again as the procedure required is outside of the benefit cover.

King regards

The Transmed Team