I am a Resolution Health Medical Aid client, on their Foundation plan.
My wife needs to go for an urgent Hysterectomy. The Dr gave me a form with all the necessary info to get pre-authorization from Resolution Health. Their call centre agent told me that authentication is declined because the ICD 10 Code is not for a PMB condition, so I called the Dr. again and was given a second ICD 10 Code, which Resolution health also declined for the same reason. So the Dr wrote a motivation and included a third ICD 10 code, that was faxed to Resolution Health. After waiting for about five hours for them to contact me, because the agent that was handling my Authorization was busy on another call when I phoned, I called them again and was informed that this was also declined for not being PMB. I asked them what the code should be then, but nobody can tell me.
The Dr insists that the codes given is correct, but Resolution Health does not accept them.
My wife also tried sorting this out, but nobody at Resolution Health can help, and there is no number where a supervisor or manager can be contacted.
The hysterectomy was supposed to be done on 02/07/2013, but will have to be postponed.
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