Summons received on 23/07/2013 for an amount of R6659.70.
I have on numerous occasions attempted to resolve this matter. But have had absolutely no response from the doctor.
This amount was charge to my account for the following:
58222 Laser Lithotripsy: First lithotripsy treatment for one or more stones in same kidney which are eliminated in one treatment.
This was not paid by the medical for the following reasons: 535/1109
535 Claimed amount has been reduced and paid at your scheme rate or
1109 EDI Claim line not valid (Categorised Procedural Terminology code not authorised).
I have been trying to resolve this since last year. The doctor is just not responding to my requests. I still have the Authorisation letter from the medical aid where you can clearly see this code was not authorised. This appears to be a billing error which i am trying to resolve. The doctor is also not responding to requests from Mr Daan van Zyl - Netcare Credit Control Manager.
This is rediculous - I am being held liable for this amount - which i am not sure if this procedure was ever performed as it was not part of the approved list on the Authorisation letter.
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