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FedHealth.co.za / Fedhealth Medical Aid / non-payment of pmb conditions consultation.

Cape Town, South Africa

My Fedhealth memebership no. [protected]. My daughter has a heart condition recognized by my medical aid as a PMB. on 27 Sept. 2018 we took her for her annual checkup with the pediatric cardiologist as required. Fedhealth only paid half the bill and sighted wrong codes for not making full payment. We resubmitted the claim with the correct codes, only for them to reverse the whole claim stating that the amount paid in the first instance was paid in error because we never got a referral letter from a GP first before we went to consult with a specialist. This is news to me! They already know the child has a heart condition which is chronic, why should we have to go pay a GP just for them to refer us to a specialist? Besides, if this were the case, why is it not stipulated in the correspondence they sent me regarding her PMB condition? I spoke to a call center agent at Fedhealth who was adamant that I should have looked at their brochure???

I would like this claim to be settled in full as the reasons given to me for none payment do not make sense at all.

Lo
Oct 25, 2018

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