I have submitted 5 claims for specialists and not one has been paid by Netcare each consultation costing me R1 100. The last 1 I even got authorization before seeing the specialist as I am supposed to and phoned two weeks after faxing the claim through. I was told that R700 odd was on the payment run and they gave me the date that it would be paid. This was 2 months ago and to date I have not received payment.
Netcare provides for 12 specialist consultations a year and even though Psychologists are specialists and these are the type of doctors you would normally need top see more than once in a year I was told that these consultations did not get covered by the 12 specialist consultations and would be paid from savings (thus depleting our savings after 5 consultations - I am meant to see the psychologist for at least 4 individual consultations and so is my wife & then we are meant to see him at least 3 times together.
My wife is the primary member and of a total of 8 claims where either 1 of us paid for the consultation, we have only ever been reimbursed for 1 consultation over the past 18 months
(Supplier name changed from Netcare to Netcare Medical Scheme by Hellopeter.com)
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