Medihelp
Physiotherapy claims repeatedly rejected

I had a fractured Medial Malleolus and eventually managed to claim PMB benefits for my treatment. After several weeks my GP said that I needed to start physiotherapy. However, as she had never referred a patient on Necesse she asked me to phone and find out the procedure for referral. I phoned Medihelp on the 8th of July and asked about the referral procedure. I was told by a male consultant that I did not need to be referred by my GP and could go to any physiotherapist. Therefore, I did not go back to my GP. I went to five physiotherapy sessions but the claims got rejected three times. The first time was for no ICD 10 code, so I gave the code that was used for my PMB benefits to the practice to resubmit. Then the clailms got rejected a further two times for 152 no referral. I phoned Medihelp on 15 August and asked why my claims were rejected for no referral and the female consultant said that the first consultant I spoke to was wrong and that I needed to give the practice my GP's name and practice number to submit with the claims. I did this and the claims were resubmitted, but they got rejected again for no referral. The claims had all the information required and should be paid.

Company: Medihelp
Country: South Africa
City: Call centre

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