Medihelp
Non-Payment of Dr chasumba claim dated 26/11/2012

I received a letter of demand from Pracmed, on behalf of Dr G Chasumba, who was a general surgeon that had diagnostic procedures done on me on 26/11/2012 whilst I was in-hospital at Brenthurst Clinic. Both procedures were approved with NO co-payment applied as ICD 10 Codes used were PMB. I then requested Pracmed to forward me a copy of proof that the claim was submitted to MH, the paper claim copy is stamped by MH's mail room on 21/12/2012, my theory is that after being received at mail room, it was never batched for processing. On 20/01/2014, upon follow-up by Pracmed with MH, they were advised the query is under investigation, this means that my name might end up with Trans-Union for the incompetence and negligence of MH claims staff. I have already forwarded an email to MH on 30/01/2014 and CMS on 29/01/2014. For the same claim, the Anesthetist was short-paid and paid the difference from my medical savings, i disputed the short-payment and referred them to the PMB Act "no limitations will be applied to the PMB and that the onus is on the primary treating Dr to supply a valid ICD 10 code. I am already engaging the media and legal advisers pertaining to this matter and 2 others

Company: Medihelp
Country: South Africa
City: Arcadia Pretoria

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