Health Squared Medical Aid review: Payment not received for mri scan

Membership : [protected], Rise Option

I was admitted into hospital in November 2020 (during the COVID-19 pandemic).

I was due for an MRI scan to be done, which my Rise Option covered MRIs, although a co-payment of R2 500.00 had to be paid. Radiologists advised me that Health Square is not covering it as my Rise Option did not allow for it. My Physician Specialist motivated a letter, whereafter Health Squared authorised the MRI scan.

In December 2021 Health Square paid R300.04 towards the MRI scan, I had to pay the outstanding balance of R9 033.45.5 months later Health Square retracted the R300.04, which by now the Radiologists were on my back for payment of R9 033.45, which I then paid on 27 November 2021.

I have been sending emails back and forth for clarity as to why Health Squared is not covering the cost of the MRI scan, which I had a silent stroke in the Brain (all of this was due to the after effects of having COVID-19). Despite their email of 7 April 2021, advising and I quote "... the claim was successfully escalated and the it will paid to the provider on the next payment run", which to date has not been paid and neither do I get feedback to my emails sent, only a "read/receipt".

Furthermore, the Physician Specialist, Heart specialist, ENT specialist and the Dietician were all paid in full. I just find that having a silent stroke was detrimental to me and that the MRI should have been paid, seeing that all the relevant specialists were paid.

To date Health squared still have not paid and neither have they given me clarity/reason as to why the MRI scan has not been paid.

I want Health Square to resolve this MRI scan payment, which is due to me and not the provider, as they have already been paid by me directly.

I await a response from Health Squared ASAP!

Regards Ms AJ.