Wednesday, November 5, 2008

Red tape

I find dealing with medical aid's extremely frustrating.

Before I could be admitted for confinement I had to obtain a pre-authorization number from my medical aid scheme. The first time I called (which was about a month before my due date) I was told to call back in two weeks because the authorization was only valid for two weeks. I was also told that because it was for confinement, I could call at any time if I went into labour because obviously I could theoretically go into labour at any time and they would then immediately give me authorization. When I called back two weeks later I was told to rather call back on the day I went into labour because that would ensure the number wouldn't expire. Fair enough I thought.

So on the morning that I started having contractions I called the medical aid for my authorization number. The call centre lady asked if my due date was still the same. "Yes" I answered, "but I'm having contractions now so that's why I'm calling for the number now". "Have you seen your doctor yet?" she asked. "No" I replied. There was a short silence, then she gave me the number. At the time I had so many other things on my mind that I didn't really have time to get annoyed.

So I went to the labour ward that evening (21 October) as I've mentioned and gave birth the next morning.

This morning I received an account from the anaesthetist and a note asking me to submit the account to my medical aid scheme. I thought this was strange as accounts are usually submitted by a doctor's secretary so I phoned the medical aid to find out if they had in fact received the account. I was told that the claim had been rejected as their records show I was admitted on the 22nd and how could the doctor operate on me on the 21st if I wasn't even there? I was completely taken aback by the pedantry. Obviously there had been a mix up with the dates somewhere, but they were using this as an excuse not to pay out. I felt my spirits sink because I knew this meant I was in for a fight and I hate fighting.

"I was admitted to the labour ward on the evening of the 21st" I said "and delivered the baby on the morning of the 22nd. And he didn't operate me, he gave me an epidural". "What time were you admitted to labour ward?" she asked. "In the evening around 5" I replied. I didn't see the relevence of the time, but anyway. "Well that's not what our records show" she said, "we'll need a motivation from the doctor". Damn, I thought. I know how much doctor's hate writing motivations. I could tell I wasn't going to get anywhere with this woman so I said goodbye and decided to call the hospital.

Dealing with the hospital was pain free. I stated my problem and was immediately put through to the right person who told me that their records showed I was admitted on the 21st but that the medical aid had probably not received their account yet. She gave me her name and number and said I was welcome to ask the medical aid to phone her directly.

I then decided to phone the anaesthetist's rooms and speak to his accounts lady to cover my bases. This was a mistake. When I told her what was going on she started moaning like a banshee. As I was listening to her tirade, I considered cutting her off and being short with her. After all, it wasn't my fault, why did I have to listen to her whining like I was her boyfriend? You don't shoot the messenger! But I decided to just let her go on because I was too tired to fight - I regretted this afterwards though. When she came up for breath after about 2 minutes of ranting, I told her I'd try to sort it out and get back to her. She then started ranting about the medical aid again before she finally said goodbye.

I phoned the aid scheme again and told them that the hospital's claim did show I was admitted on the 21st. I was told that the authorization was for the 22nd. You have got to be kidding me, I thought. After all the run around I got from them about the authorization? This just pissed off. I was put through to another department.

Once again I stated my case to the next person I spoke to. She put me on hold to check something and when she came back she told me that the project manager wasn't in so she took my number and told me... she'd call me back.


rlbates said...

Absurd!!! Don't back down. You may not like fighting, but stand your ground.

amanzimtoti said...

rlbates it is absurd and I will stand my ground. I actually left my previous medical aid scheme because of problems with them paying out but it seems they're all the same.

Dragonfly said...

Well, you can't complain about the service provided by the aid company....cause there was none! (Dad joke, I know).
Hope the new bub is going well.

amanzimtoti said...

She's very well :)

Jabulani said...

Being a pedant myself, I loved this blog. It reminded me of my experience - from the insurance company side!! I might just blog it; thank you for the inspiration. Just out of interest, what was the end result?

amanzimtoti said...

Jabulani, they did not in fact get back to me. I called them again about a week later and was told they had decided to approve the claim, but they would only put the payment through with the next pay run. I then received a letter from them about a month later saying they had paid part of the claim from my hospital fund and the other part from my savings account. The part they paid from my savings was only partly paid though because my savings account was already exhausted. I can't understand why they paid it in that way though since it was one procedure (with the cost broken down into different codes) done while I was admitted in hospital. What can you do?

Jabulani said...

You have got to be kidding me! I thought our claims procedure was bad, but that's preposterous.

I can't help thinking tho' despite all the doom and gloom of this episode, you DO get to enjoy the bonus of your beautiful daughter, for whom ANY fight will be worthwhile.

Craig Taverner said...

I'm suddenly very happy to be living in Sweden. With both births we didn't have to think of anything related to red-tape. And no phone calls. When we went to the hospital, Mia gave birth, we stayed five days due to minor complications (Mia's blood pressure), and then went home once Mia was feeling better.

A few weeks later we received a bill of 200SEK (about £15). And they even let me stay with Mia in the hospital the entire time. I must admit I had to buy my own food, while Mia's was covered for, but I paid nothing for the bed. Basically everything was covered by the state insurance.

Jabulani said...

Craig - I can better that! I had both of my children at home so there was absolutely no cost involved ... unless you count the cups of tea we had to provide for the midwives.

And, over the past 5 years, following a break to her arm, my daughter has had 4 operations, countless consultations and spent 5 days in hospital. There has also been absolutely no cost for this treatment. That's the benefit of the NHS.

The downside of this tho, is that you have to wait ages for an appointment, run the gauntlet of general wards as opposed to private rooms and get shunted hither and thither so that you become a statistic rather than a patient. Oh yes, and the cost of the parking fees could probably fund a junior doctor's annual salary. Apart from that, it's perfect ;)

Amanzimtoti - I'm just off to blog that insurance story I mentioned way back in December ...

vibradores said...

Thanks so much for the post, pretty helpful information.

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