Disappointed Client

This is the first claim I've ever submitted to Zestlife for a co-payment that I had to be pay in order for me have a CT scan that I had to have when I was admitted to hospital to check for blood clots on my lungs.

This scan was done after I was admitted to hospital and it was not an out-of-hospital procedure like Zestlife is insinuating, because the medical aid would not have covered the cost of the scan if it was done out-of-hospital, the medical aid stipulated this strictly, when the ER Doctor tried to have the scan done prior to me being admitted. The medical aid stated that if I have the scan done out-of-hospital, I would have to pay the whole cost of the procedure which was over R14000 but if I am admitted to hospital then I would only have to pay a Co-payment. I didn't have R14000 to pay for the scan so Doctors who needed the scan done decided to admit me to the hospital. I stayed in hospital for 1 day just to have this scan done and make sure my lungs were ok.

After submitting all the documentation required, Zestlife is saying that the procedure (scan) was done out-of-hospital and that the claim can not be processed because of this. Had they checked with the medical aid they would have realised that the procedure would not have been approved by the medical aid, and therefore it could not have been done out-of-hospital.