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Fazeelah B
1 reviews | Active since Nov 2021
16 Sept 2025, 09:28
First Claim for my yearly check up declined!
My claim was not approved because I went for a Mammogram on 24.06.2025 and according to them it is within a year of my last visit on 09.07.2024. It was my first Mammogram in the calendar year of 2025 but they rejected my claim. My argument is that If I went for more than a Mammogram in 2025 by all means I would pay for it. But now they are declining to make payment for one in the year that I am in.
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Replies (7)0
Replies (7)
Umvuzo Health Medical Scheme's replyOfficial
16 Sept 2025, 09:36Dear Fazeelah,
Thank you for bringing the unpaid claim to our attention. We’re sorry to hear about the inconvenience caused.
One of our consultants will be in touch with you shortly to explain the reason for the rejection.
Kind regards,
Umvuzo Health
Umvuzo Health
Umvuzo Health Medical Scheme's reply16 Sept 2025, 09:36
Official
Dear Fazeelah,
Thank you for bringing the unpaid claim to our attention. We’re sorry to hear about the inconvenience caused.
One of our consultants will be in touch with you shortly to explain the reason for the rejection.
Kind regards,
Umvuzo Health
Umvuzo Health
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Fazeelah B's updateReviewer Update
16 Sept 2025, 09:44I do not want the same explanation from another person I want my claim paid!
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Fazeelah B's update16 Sept 2025, 09:44
Reviewer Update
I do not want the same explanation from another person I want my claim paid!
Umvuzo Health Medical Scheme's replyOfficial
16 Sept 2025, 09:56Dear Fazeelah,
Thank you for your continued engagement.
We would like to inform you that one of our consultants attempted to contact you regarding your claim, but unfortunately, the call could not proceed as you declined to engage in the conversation.
Regarding your claim, please note the following:
- In line with our funding guidelines, a mammogram is covered once every 365 days.
- Your previous mammogram was done on 2024/07/09, and the subsequent one was performed on 2025/06/24—a period of 351 days.
- As this falls short of the required interval, the claim was rejected under the reason: “Tariff used within the prescribed period.”
We hope this clarifies the outcome. Please feel free to reach out if you have any further questions or require assistance.
Kind regards,
Umvuzo Health
Umvuzo Health
Umvuzo Health Medical Scheme's reply16 Sept 2025, 09:56
Official
Dear Fazeelah,
Thank you for your continued engagement.
We would like to inform you that one of our consultants attempted to contact you regarding your claim, but unfortunately, the call could not proceed as you declined to engage in the conversation.
Regarding your claim, please note the following:
- In line with our funding guidelines, a mammogram is covered once every 365 days.
- Your previous mammogram was done on 2024/07/09, and the subsequent one was performed on 2025/06/24—a period of 351 days.
- As this falls short of the required interval, the claim was rejected under the reason: “Tariff used within the prescribed period.”
We hope this clarifies the outcome. Please feel free to reach out if you have any further questions or require assistance.
Kind regards,
Umvuzo Health
Umvuzo Health
FB
Fazeelah B's updateReviewer Update
16 Sept 2025, 09:59Yes I told him I do not want to listen to the same explanation again! And yes I already stated that in my review and I’ll say it again we are in the year 2025 and no one is going to convince me otherwise!
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Fazeelah B's update16 Sept 2025, 09:59
Reviewer Update
Yes I told him I do not want to listen to the same explanation again! And yes I already stated that in my review and I’ll say it again we are in the year 2025 and no one is going to convince me otherwise!
Umvuzo Health Medical Scheme's replyOfficial
16 Sept 2025, 10:11Dear Fazeelah,
As mentioned in our previous communication, the lapse period for a mammogram benefit is 365 days, regardless of the calendar year.
Please note that your claim will remain rejected, as it does not meet the required waiting period. Unfortunately, this means you will be liable to settle the claim directly.
We understand that this may be disappointing, and we remain available should you need any further clarification or assistance.
Kind regards,
Umvuzo Health
Umvuzo Health Medical Scheme's reply16 Sept 2025, 10:11
Official
Dear Fazeelah,
As mentioned in our previous communication, the lapse period for a mammogram benefit is 365 days, regardless of the calendar year.
Please note that your claim will remain rejected, as it does not meet the required waiting period. Unfortunately, this means you will be liable to settle the claim directly.
We understand that this may be disappointing, and we remain available should you need any further clarification or assistance.
Kind regards,
Umvuzo Health
FB
Fazeelah B's updateReviewer Update
16 Sept 2025, 11:05Mxm
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Fazeelah B's update16 Sept 2025, 11:05
Reviewer Update
Mxm
Umvuzo Health Medical Scheme's replyOfficial
01 Oct 2025, 09:19Dear Fazeelah
We have contacted the Radiology Department to request the actual account and will forward it to our Medical Advisor for review.
You will be provided with feedback on the outcome in due course.
Regards
Umvuzo Health
Umvuzo Health Medical Scheme's reply01 Oct 2025, 09:19
Official
Dear Fazeelah
We have contacted the Radiology Department to request the actual account and will forward it to our Medical Advisor for review.
You will be provided with feedback on the outcome in due course.
Regards
Umvuzo Health