Fedhealth Medical Scheme
Fedhealth renaging on pre-authorisation

In December I needed a hysterectomy. I requested pre-authorisation & Fedhealth said they would not pay the laparoscopic portion of the procedure but would pay the value of the open procedure "up to average hospital cost of R29 437 for abdominal hysterectomy." Unfortunately my surgeon only does laparoscopic procedure so I had no option but to proceed on this basis.
The surgery took longer than anticipated & the final bill from Rosebank Clinic was R53549. Rosebank submitted an itemised bill to Fedhealth but they kept rejecting it. Finally Rosebank submitted a lower bill based on a procedure (R21738) which Fedhealth approved.
However this amount is considerably below the amount that Fedhealth originally agreed to pay which is NOT ACCEPTABLE, PARTICULARLY in the light of the much higher overall bill which remains R53549.
The procedure WAS NOT a procedure & to use this as the basis for payment leaves me with more than 50% of the bill to pay and is a breach of their agreement to pay the pre-authorised amount. At a BARE MINUMUM Fedhealth needs to pay the R29437 as per the pre-authorisation letter and in fact should be paying more considering the length of the procedure.

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

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