AW
Audrey W
Active since Sep 2011
4
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0
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Reviews
4 reviews79 months ago
SHOCKED that any Medical Aid has the authority to override a specialist script for high cholesterol
I am an oncology patient. The meds I am on has a side effect of raising your cholesterol and BP. I have just been for a Lipogram. The surgeon (specialist) strongly advised that I go onto a statin to lower my cholesterol (readings: Total=6.7, LDL=4.4 Triglyceride=2.25 and Non HDL=5.1). I sent the lipogram and script to Fedhealth. They have just come back saying: "Authorisation for payment of the condition - Hyperlipidaemia, unspecified - has been declined. Funding of this diagnosis is only considered for patients who meet risk score criteria, as set out by the Medical Schemes Regulations that define funding obligations." How high and how many areas of pathology marked "H" do they need before they will cover the condition!!!! I am SHOCKED that any Medical Aid has the authority to override a specialist script for high cholesterol, when our Dr's are fighting to keep us healthy. Is Fedhealth going to be there if (God forbid) I have a strokeor heart attack? No, they'll just send an email DECLINING aspects of any claim. I am angry and frustrated as you NEVER get to actually speak to the person (clinical consultant) who makes the decision. At the cal ...... it will be esculated (I HATE that word)
210 replies
113 months ago
40% PENALTY for using a PHARMACY OF MY CHOICE
<p>SHOCK SHOCK. A new year and a BAD start to this year with Fedhealth!</p> <p>I went to collect my chronic meds from the pharmacy that I have been using for 18 months already, and sat with a co-payment of R557.06 for my meds. WHAT?? I take adjuvant therapy for breast cancer, so cannot NOT take it, so was forced to pay it. My husband and I pay R6739 a monthly for medical aid. I needed to query this over**** of co-payment. SO THE BATTLE STARTS:</p> <p>1) to get through to someone ..... ta dum ta dum ta dum</p> <p>2) Spoke to Chanelle who informed me that a 40% co-payment was charged as I got my medication from a NON DSP provider. WHAT??? I have been using the same pharmacy for almost 18 months.</p> <p>3) Chanelle explained that the Designated Service Providers for Fedhealth from 01 January 2017 is Medi-Rite Pharmacies, Dischem and Pharmacy Direct. Should you NOT use one of these 3, a 40% co-payment will be levied. I told her I am NOT going to pay this 40%, and wanted to speak to a supervisor or manager that would Or COULD make decisions and not BLOCK me - I wanted answers!!</p> <p>4) The popular answer when the consulants are at a loss - ""I will esculate the query for you"" - but where it gets esculated to goodness alone knows.</p> <p>5) I furthermore wanted to know when, where and HOW they notified their members. She said in the October Montly Newletter it was advised. I asked her</p> <p> WHERE in the newsletter and she said under Chronic Medication. Asked her further where under chronic medication, and she said under DSP's. I asked her to please read it to me and it went something along the lines of ..... DSP's for Fedhealth wil be MediRite and Dischem (somewhere Pharmacy Direct also came in) and should you not use the preferred DSP ..... according to the formulary something that sounds like GREEK to me ..... you will pay a 40% co- payment. And there - somewhere in a monthly newsletter you are advised of</p> <p> A REALLY IMPORTANT fact that YOU WILL PAY 40%. SHAME ON YOU FEDHEALTH. WHY was a straight forward letter not emailed or posted or boldly noted on the monthly statements of this fact? What about your members that have no PC at home. People that are NOT allowed to go onto</p> <p> non work related sites from work PC's (so cannot spend 30 minutes reading EVERY newsletter from EVERY company they support, with a fine tooth comb</p> <p> IN CASE it is going to cost them a wack load of extra money they have not budgeted for - and get a SHOCKER just as I did. But pay, you have to as you need the meds. It is CHRONIC meds after all.</p> <p>6) When I told her I INSIST on speaking to a supervisor and AM NOT going to accept paying this 40%, she said that I could take the meds back to my pharmacy</p> <p> and they could reverse it. I could then go and get my meds from a DSP. Fedhealth, SURELY as a medical aid provider, you TRAIN your consultants - and they, better than ANY other person should know you MAY NOT return medicines - it is against the law for a pharmacy to take back and resell medication. And this would all take how long to sort out? Without meds?</p> <p> Would Fedhealth be willing to give me a letter in writing that they accept FULL responsibility that during the time that I will not have meds (to exchange one DSP for their PREFERRED DSP by exchanging meds - if I could), that should I get sick because I never took my medication for a few days, they will cover any and all expenses? </p> <p>7) LASTLY I went and checked for this famous newsletter that advised us of this new ruling ..... we keep EVERY email sent to us by Fedhealth and did NOT receive any newsletter in September or October advising us of any such ruling. The email address Fedhealth "supposedly"sent the newsletter to was correct, but, we never received it. I therefore request the read receipt or proof of this</p> <p> correspondence, containing this ruling, having been emailed to us please.</p> <p>8) My call reference is 100117Q31RYR and was made on 10th January 2017</p> <p> at 16h11. Your explanation and feedback would be appreciated. Our membership number is 80600 396 859</p> <p>9) Surely there is some sort of ""ombudsman"" to protect members of medical aids</p> <p> against rulings such as these, unless they have agreed to it?</p> <p> </p> <p> </p>
56 replies
129 months ago
FANTASTIC food, great attitude and service
Had dinner at Giovanni's in Somerset west, Waterstone Village on two occasions now.<br> Both times the food was superb, friendly and super efficient staff.<br> You have to book to get a table inside .... :-)<br> Fantastic and we'll not easily eat Italian food &
0 replies
129 months ago
DEAD SOMETHING in Spekko Rice
I purchased a 2kg of Spekko white rice at a store. About 1/3 bag of rice was used. I was going to make rice, so poured some into a holder to rinse & cook. I saw what appeared to be clusters of cardboard like grains -similar to mite. Feeling \yuck"I checked the 2kg bag (has a broad orange band at the bottom so you can't see through) & found a hard mass of moulded \""something\"" that seemed to have some hair on parts of it (possibly a dead mouse?). I took photo's of the green dry mould & \""thing\""<br> through the packet as I did not want to inhale it. I called their customer care line and the lady merely wanted my postal address & details of the packaging. I told her I am NOT interested in a replacement bag or voucher from them - I want them to collect the bag to check what was inside"
75 replies
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