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Question
Posted by: CP MOM | 2007/04/25

My surgeon

Hi CS

My accounts have all been settled with all the specialists, drs ect but not the surgeon, there was a lot of admin problems ect but i've now received all.

The medical aid (hospital plan) refuses to pay for any visitations after the ACTUAL operations as "it should have been included in the operation fee".

I mean how must the dr. know how many times he's going to need to come and see me ? How does he know if there are going to be complications like drainage pipes not working and many other little things comming up that he was called to attend to while i was in ICU.

The dr. wants it paid and the medical aid say's no.

Is there anything I can do ?

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Our expert says:
Expert ImageCyberShrink

I ran into this, too. After a basic operation, I gather that a routine number of follow-up visits or consultations are considered as non-billable and included in the operation fee. But with my 1st and 2nd op, the surgeon charged me for every one of the many follow-up visits ; after the 3rd op, the new surgeon did not. The rules probably make provision for complications, though, if these are unexpected and not due to negligence by the original surgeon, and may provide for some payment for visits necessitated by these.
Worth disusing with someone more senior at the Medical Aid

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2
Our users say:
Posted by: CP MOM | 2007/04/25

Im waiting for the supervisor to phone me it does not make sense to me either....will go look at your posting.

Reply to CP MOM
Posted by: H25 | 2007/04/25

Hi CP Mom

Are you saying your medical wont pay for actual hospital visits after the op? If so, that's ridiculous! If they were visits after you were discharged, then yes, they might not pay for them. But as far as I am aware as you have a hospital plan you are entitled to refunds for as many visits as was necessary while you were in hospital. It surely doesn't take a "professor!" to realise that he is obviously going to charge you for visits he makes!

You might want to take up this issue with the Medical Schemes Act. I think their website is medical schemes.com but Google it and you will get the correct address.

See my posting 2122!

Have a good day.

Reply to H25

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