Firing our medical aid

I have officially had it with our medical aid and am looking into changing. We have been with Momentum for about 6 years and haven’t had any problems until this year. Firstly, when Ava had her fall off the bed and needed I wanted her to have a CT scan, they only paid R300 of a R1700 bill. When I phoned them to ask why, I was told that there is a R1500 co-payment for special radiology. We pay R3500 per month for our medical, what for? Yes, I know what for as my husband works in a government hospital and I know I don’t want to land up in one, but a R1500 co-payment on a R1700 bill is just the pits I think. Then, they are supposed to pay for my annual gynae check-up and pap smear and haven’t. Why? Because I didn’t phone for authorisation!!!! What lazy bliksems. It is quite clear from the doctor and pathologyist’s bill exactly what the visit and pathology was for, that’s why they introduced all these complicated coding systems. The codes indicate quite clearly that the account is for an annual check-up and a pap smear analysis. Why must I still phone them and tell them I’m going? In what obscure place in some fine print of some document that they sent me was that written? The same thing happened with our annual dental check-ups so yes, maybe I should have learned a lesson, but what am earth am I paying all those idiots to sit behind their computers and do? Surely, I don’t need to do everything for them. Surely their computer system is clever enough to figure out what an annual dental/gynae check-up is, if it clearly states that in the specific code that the doctor or dentists use. And just let the doctor get anything wrong and they’re very quick not to pay him either. This I know because of all the troubles Chris has with medical aids and their ducking and diving. Over the years they’ve also gradually decreased their benefits (or introduced co-payments) but still upped their premiums each year. So, I’ve phoned Fedhealth and hopefully we’ll be new members as from 1 November. Thank goodness we’re all healthy and none of us have any pre-existing medical conditions. The one ironic thing is that Fedhealth is one of the few medical aids that pay for fertility treatment. Won’t be needing that benefit!? Definitely not considering how badly little miss Ava is sleeping at the moment.


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