Fedhealth Medical Scheme
Payment required for authorised and approved claim

I have submitted a claim for payment to be made according to scheme rates of 100%. Fedhealth have sent me authorization codes and approved the procedure. My wife had a caesarean section on the 08/08/2013. At the time of the claim I had sufficient benefits and the authorisation codes and approval.

After nearly 4 months this has not been resolved. At first they declined the claim as they had submitted the wrong date which was their clerical error not mine. The date was for the 08/07/2013. I called and advised them to correct this mistake which they did. Then submitted the claim again and received a response no benefits available. This claim has been submitted 4 times since August and I get the same results although as per Terms and Conditions - the claim will be paid according to scheme rates and benefits available to the client at the time of the claim.

After receiving additional communication that approval was given and payment is to be made I have recently just received another identical response to my claim that I have no benefits and that the claim has been reversed. I need an answer now and payment as advised or I will terminate this policy and move on to greener pastures.

Company: Fedhealth Medical Scheme
Country: South Africa
City: Johannesburg

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