Key Health Medical Aid
Non-payment of claim

My mother had an operation on 10/11/2011. Authorisation was given by Keyhealth before the op. My mother was in ICU for 5 days after the op before passing away on 15/11/2011. Keyhealth paid the account for Bloemfontein Medi-Clinic in December 2011 (around R150k) and then reversed the payment. The reason given was that the surgeon performed a procedure that wasn't authorised. The case was referred to the Medical Schemes Council and additional information was requested from the surgeon. Keyhealth was not happy with the response from the Medical Council and referred the surgeon to the HSPCA. A response came back from HSPCA that the surgeon did nothing wrong. Keyhealth has AGAIN appealed the decision.

So more than a year later Keyhealth is still delaying payment unnecessarily (according to the Medical Council and the HSPCA) and my family cannot settle the estate and move on. Nobody can help me - the managers are always in meetings; call centre staff promise to call back and never do.
I am absolutely disgusted that a medical aid can do this! I have since heard from a number of sources that Keyhealth staff are incentivised to delay paying out claims as long as possible...

Company: Key Health Medical Aid
Country: South Africa
City: Claims/Authorisations

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