Medihelp
Unpaid PMB in-hospital claim by a Max-Fac docto

I have on 23 April forwarded an email to client services/medihelp/claims dept and no response, this is the alternative way to communicate with MH as they do not respond to normal correspondences, a claim by Dr Kola, a Max-Fac was declined statement dated 30.04.13, code 400-No PMSA available and no statement 94, Dentist account in Brenthurst Clinic, admission date 13 March 2013, for a PMB, DTP condition, rule:543C was paid from my PMSA (R224.00), as per PMB rules and guidelines it is said: "the onus is on the treating provider to supply the valid ICD 10 Code", meaning whatever ICD 10 Code used by the secondary provider, the claim will be successfully be allocated as PMB and be paid accordingly, these claims are not a dental treatment, but a dental assessment in-lieu of a PMB hospitalization, post maxillo-facial complications. Does this mean if you've a complication related to dental, you may not be referred to a Dentist/Max-Facial by a primary provider as that will be considered your liability. I am truly disappointed that I have to resort to this measure of correspondence as i have grown tired of wasting my time and money calling, and emails are NOT responded to.

Company: Medihelp
Country: South Africa
City: Arcrdia, Pretoria

  <     >