My son had his adenoids and tonsils removed, which I got authorisation from Medihelp for. On the authorisation form that I phoned through to the medical aid there was a code 1052 - the lady that gave me the auth code said that there might be a co-payment if a special instrument is used with the examination. I asked her in how many cases it happens and she said not often. I got an account from the hospital as the medical aid short paid R2120 for that code but on the dr's quote the amount charged for that code is R1052 so how on earth is that possible that you now have to pay 2120, I have checked with the hospital and the Dr's rooms whether they used the special instrument and both said NO - they just did the norm - I have queried this more than once with Medihelp and they are just simply refusing to listen or understand. NOW they tell me that the hospital should give them a different code if the instrument wasn't used but it was never mentioned previously - I WAS NOT TOLD THAT THERE IS DEFINITALY GOING TO BE A CO-PAYMENT - ONLY IF A SPECIAL INSTRUMENT GOT USED WHICH DID NOT HAPPEN. So I honestly do not know why they are refusing to pay and I am at my wits end with this whole issue
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