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They have long stories to pay out my money they need to pay me after I've paid the medical bills eg. Hospital and gino for the birth of my baby. Every time it is a different story when I phone them. If you can help my no is [protected]
The complaint has been investigated and resolved to the customer’s satisfaction.
When I found out I was pregnant, I called Resolution Health to register for the RESO BABY and they then advised me that my scheme option has changed from January 2013 and I am now bound to certain hospitals within their network. it did not cover the hospital that I want to deliver my baby at. They did not even inform me properly of this change in the first place.
After a request to upgrade my option ( to one which covers any hospital), they accepted the request after going through a lot of trouble, phone calls, emails and determintation and I was upgraded. THEN - when I went for my routine checkup at KLOOF hospital, they advised me that they do not cover patients from RESOLUTION HEALTH. This was now after upgrading my contract specifically NOT to be bound to any hospital as my option now stated that I can go to ANY hospital (NO EXCEPTIONS). I then called the Resolution call centre numerous times with my complaint (+/- 2 weeks now) and to date, NOTHING has been done about it and NOBODY has responded to my query.
I strongly believe that the issue the hospital has with the medical aid should be sorted out by the medical aid and that I, the patient, should not be prejudiced by this! IT IS NOT ACCEPTABLE! I have been a loyal medical aid client, always paying my monthly contributions and I expect the same from them! I want to be able to make use of all the benifits my medical scheme option states and at the moment I can't!
Please note according to the Medical Scheme Act 131 of 1998 a medical scheme must pay either the service provider or member (in your case as you have already paid will be you the member) within 30 day's. If they do not, you should take this up with the (CMS) Council of Medical Schemes. You can also contact the Principal Officer of your scheme. You will find there details on google if you type in " principle officers of medical schemes south africa" It will give you all the schemes, choose your scheme and contact the person, together with CMS
We have trouble with payments as well. We joined Resolution in 2008on a hospital plan from a full medical aid, because of financial reasons. We paid our premiums timeously every month and only claimed more than a year later for the first time. It was for sonars on the resobaby program and from the start struggled to get authorization and payment. I registered on resobabyat 12weeks and was promised a babypack within 6 weeks, but only received it 5 weeks before I gave birth. Many of the dr. accounts for the birth and compulsory blood tests of the baby during hospitalization was not paid and in the end I had to pay them myself. And so the story continues. Every claim that was submitted, was answeredwith a lot of excuses and lies. My little boy had a pilmonary valve replacementat Universitas hospital in Bloemfontein. We as still strugglingto get some accounts paid. My child is registered as a PMB and all procedures were done in a state hospital by state docters. Resolution claims that the drs. and Lab was contracted out. (the hospital used the National State Lab for all testing, and I saw all the dr accounts, all were submitted at medical aid tariffs. I am so fedup with them, but can not move now because of my childs condition and the exclutions another medical aid might enforce if we move. Give me some advice as to which aid is good. I will discourage anyone to ever join Resolution.
M Breytenbach([protected])