Resolution Health Complaints & Reviews

Resolved Resolution HealthService not being fullfilled

I would like to complain about Resolution Health as they are useless when it comes to covering their clients.
I went for my annual checkup (13 March 2012) at my gynecologist and as a routine check they did a pap smear. Then when I got home my husband and I decided to apply for medical aid as he will be working at heights as a rope tech and it would just be safer in the long run.
Then we applied for Medical Aid and we got accepted with Resolution Health on the 1 April 2012. Just before they accepted us, my doctor phoned me that I need to come into his rooms again to discuss the findings in the pap smear. We made a booking and I saw him again on the 27 March 2012 where he told me that there are cells that needed to be removed otherwise they will turn cancerous in the next 3-4 months.
The very next day I went to the police to make a affidavit and got all the notes etc from my doctor and sent it to the medical aid to inform them. After they had received all i was still approved for membership without any exclusions.
My doctor in the mean time gave me a date for the Operation which was supposed to be yesterday 12 June 2012.
I sent all my pre-authorization forms to them etc and got an email back from them almost 2 weeks later saying I have been terminated do to non disclosure of factual clinical information...
This is not acceptable as they have now waited 3 months of me paying my premiums etc and now all of a sudden they have a problem covering me when I need coverage.
There reason is that I did not let them know when filling in my Resolution Health Application forms about the visit to my gynecologist. How should I have known at the time there was something cancerous inside of me? Eg: Should I have told them about a doctor’s visit I had a month ago because I had a headache and then 3 years later its brain cancer and then they won’t cover me because I did not let them know about the routine doctor’s visit.
I am at the end of my rope and my broker is doing everything in her power to get through to them because she knows they are wrong and they are just not coming to the party.
I am not very good at explaining my problem but have done so as best as I can.

Resolved Resolution HealthClaims not being Paid

In June Resolution Health confirm that they will pay claims still outstanding since Dec '10. As per the supervisor this claims will be paid within 7 working days and comfirmed that this is a mistake on their side! Since then I have not received any feedback from Resolution Heath, I have been sending emails on a weekly (daily) basis - no feedback. When I phone them I get empty promises that someone will phone me back and that the problem will be sorted immediately and the accounts will be settled.

Nothing happens, Now I am sitting with a bad credit record because of Resolution Health. I don't think this is a way to treat client that pays their debit order every month on time??????

I will not recommend them to anybody - They WILL let you end up in financial trouble!!!

  • Be
    Bernadette Longueira Jun 03, 2016
    This comment was posted by
    a verified customer
    Verified customer

    Good Morning, Our Membership For Progressive Flex Medical Aid is: 18486390. Main member Bernadette Y Longueira - Dependant: A C Longueira. My husband collapsed on me twice one Monday morning in July 2014. When he collapsed the second time, my son and I decided that we could not wait for the ambulance and rushed him to the Emergency Room at the Clinton Clinic in Alberton. He was admitted through the Casulaty Department by the Doctor on duty after consultation with a Specialist. My husband spent two days in ICU had numerious test done and a MIR Scan. I thought at first that he had, had a stroke. But at the end of it all four days in hospital altogether, we had discovered that he had phenomia and high blood pressure.
    He was discharged on the 5th day from the Hospital we did not receive any bill, but I thought strange any medication that he was to receive on discharge was to be paid by the medical aid. It was not so my son forked out the money for his medication. My husband had been given a date for a follow up visit to the Specialist to see if he would be permanently on the blood pressure tables or not. We attended this appointment - to discover that he would be permanently on high blood pressure tables and that he had been suffering from high blood pressure for a while. My Husband with be 79 years old on the 7th December this year. Basically we both are in good health. we do not abuse our medical aid and only use it in an emerncy or when we need to renew our scripts. I have a lazy thyroid and now my husband has High Blood Pressure. That is the only cronic medication that we take. From the end of August I have been receiving SMS and phone calls from Causualty Doctor - Not Paid rejected - Blood Tests - after out of hospital for colestrol - rejected in sufficient funds. Funny we did not have any blood test this year - how can it be finished - to be told used up when my husband was in Hospital. According to the package that you can see on their web page when it works - If in hospital such things will be paid from that fund - Now I was confused. I phoned the Casulatiy Docotor to find out why not paid -Insafficient funds and the same with the Specialist. By my calculations we had more than enough funds to pay all these proceedures and then some if the people in Resolution Health had applied out package correctly. It was an emergency - we did not visit the Emergency room for a minor thing it was a major problem and my Husband was admitted to ICU for 2 days and ward for 2 days. So why am I pay approximately R3, 000 a month to them. If either of us land in an accident and are in hospital - no proceedures will be able to be done or continued because we don't have sufficient funds. Yet we have a Hospital Plan. This is the first time we have had to use a new Medical Aid. We where with our last medical aid for over 30 years and it it did not close its doors we would still be with it. Please can somebody find out why they are not paying what they have to correctly. Thank you Bernadette Longueira

    0 Votes

Resolved Resolution HealthUnpaid bills

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]

  • Ma
    Marlize Breytenbach Mar 22, 2011

    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(18044031)

    0 Votes
  • Od
    Odette Van Rensburg May 18, 2011
    This comment was posted by
    a verified customer
    Verified customer

    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

    0 Votes
  • Sa
    SasNys Mar 04, 2013
    This comment was posted by
    a verified customer
    Verified customer

    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!

    0 Votes

Resolved Resolution HealthBad Customer Liason

I am really not impressed with Resolution health and think that you guys need to brush up on your customer services as well as your communication skills.

On the 17/12/2009 I received a text message on my cell phone stating that my income details for 2010 has not been received and that my premium will be defaulted to the highest premium. I have not received any notice/letter or even a call to say that my details should be updated, when I tried calling the help line I was kept on hold for more than 10 min on several occasions so my query was still not attended to. Now my question is “how can Resolutions just assume that I was notified about any changes to my premium or that my details should be updated?” and how pathetic is this company to send me a random sms notifying me of this change? Now it’s not my intent to shoot the messenger but this is really not acceptable I think Resolution Health should have made more effort to reach me and should have requested my consent to deduct such a huge amount from my account.

Now I am not going to waste my time with this matter anymore I consider what you did as theft, so I want my money refunded by end of the month or I am going to cancel my membership if this cant be done as I consider a medical aid as high priority and would rather opt to go with a company that is more focused on customer liaison and delivery and effective service.

Kind regards

Emile Jordaan

Membership number: [protected]
Identity number: [protected]