Commed
COMMED refuses to pay practitioners

WE treated a patient in the hospital for a PMB condition. We were not aware that COMMED med aid required preauthorisation for physiotherapy, and was only notified of this in June 2013. Apparently according to Mbulelo the med aid will provide auth for claims from Jan till March but nothing after this. Also she states that they sent out a notification in Jan that physiotherapists require second auth to treat patients in hospital. HOwever, the medical practitioners were only made aware of this fact in June, which means all claims from Beginning April till June are not going to be paid. The members are paying their monthly fees and have been told by the medical aid that they can go into hospital for the PMB condition and have been given auth to there, they are now saying that they needed a second auth for physiotherpay and that they are not going to pay this account. I find their lack of communication appalling and now they are pointing fingers at the SASP, stating it was their job to notify us. Why did they not tell the member when they were being admitted that they require a second auth for physio. They can see the ICD10 code the patient is being admitted for.

Company: Commed
Country: South Africa
City: Centurion

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