Resolution Health Medical Scheme
Deliberately Unethical

My son had a consultattion with an ent specailist on 14th June and thereafter was referred to hospital to have a procedure on 28th June. I obtained authorisation well in advance for both the consultation and the hospital procedure. On 7 July I submitted the claims and received my statement for July which reflected that both claims had been rejected and the reason given was that no authorisation had been obtained. I contacted pre- authorisation to confirm that all was in order and it was confirmed that all was on the system. On 16th July I contacted client services and spoke to Tahlita who said that she would escalate the claims. On the 16th July I also contacted my broker at Optivest who confirmed via email that she too had escalated the claims. On 28th July I again submitted the claims including a letter of motivation from the ent specialist to substantiate the claims. Despite all the above my claims have still not been covered. I find this to be completely unacceptable and deliberately obstructive and unethical. As one of the top 10 open medical aid schemes in SA why then the complete lack of integrity and service delivery?

Company: Resolution Health Medical Scheme
Country: South Africa
City: Cape Town

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