Thebe Medical Aid Scheme
CLAIM REFUSED TO BE PAID

My son was referred to the specialist while in the hospital, obviously there was no communication between medical aid and the member (Me) to inform me or get authorization to refer the child to the specialist.

So I had to pay cash for the services rendered because they don't take medical aids.

I called my Medical (Thebemed) and asked if my claim would be paid for the cash I paid to the paediatrician and 2 of the Consultants said the claim will be paid and I still have the reference numbers for both calls. Now they refusing to pay my claim because they say the child was not admitted in hospital it was a new born. Now they saying the mother should claim on her medical aid and my son was on my medical aid not the mothers.

So I was led to believe that the claim will be paid but now they refusing, So what steps should I take?

Company: Thebe Medical Aid Scheme
Country: South Africa
City: GAUTENG

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