So, last weekend ( a week ago) was another rather painful one. My external swollen vein (external haemorrhoid) had reoccurred, and I spent Saturday and mainly Sunday in serious discomfort.
Monday morning, off to the surgeon, and he admitted me to hospital again.
However, before he did, they called my medical aid, to get a admission code (i.e. authorization for hospitalization so they will pick up the costs). It was denied!! HUH? 7 weeks ago I had the same op, and it was approved no problem. Now it's declined as it's not on the authorized operations list? What? Do me a fucking favour and get upto speed with life u fucking morons!! Well, that's what I told the doos on the phone.
No problem, I tell the doctor he's still doing the operation - I'll pay for it. So I get admitted as a private patient, have to fork out ZAR6k upfront for hospitalization.
On Wednesday I went back to get a sick note, and pay the surgeon. Just waiting for the anaesthetists bill now.
OK, so I'm back home, and start to do the first email. I copy everyone and his mother, but most importantly the two guys who represent us on the board of trustees.
My email:-
About two months ago I had to be booked into hospital for an operation. I was given authorisation, and had the op. Yesterday I had to have the same operation again. When we called for authorisation, it was declined as this is not covered by the medical aid. ?!?!?!?
I have no idea what is going on here, suffice to say that it would seem you have absolutely no idea what you are doing with regards administering this medical aid.
I paid for the hospital (R6000.00) deposit myself, and have told the surgeon, anesthetist, and hospital to send me their bills as I will pay for this, but will not let it rest here.
Last time I raised an issue I got a call from someone who "explained' to me how this medical aid works. Now I expect someone to call me, to make an appointment to come and see me, so we can sort this out. As far as I am concerned, ever since Discovery took over the administration of the xxx medical Aid, it has been a total mess. No surprises then that all of the medical service providers I was in contact with yesterday said they were not surprised with the declined service from you.
Their response:-
Thank you for your recent contact with Discovery.
Hospital approval
We approved the same procedure in April 2009, according to our clinical protocols, the time period between the first procedure and the second procedure is very short. Please ask your Dr to send us a motivation before we approve the second procedure.
"according to our clinical protocols".... what the fuck?? Clinical protocols - who the fuck cares about that? You think my piles have read your protocols you stupid dumb fucks?
So, my response to theirs:-
The motivation is a recurrence of an external Haemorrhoid's, which left me in incredible pain for the whole weekend, till I could see him on Monday, to have it cut!!!
What do you think? His office phoned you just for fun? Do you really think this is how our professionals operate? Just because Discovery Medical Aid administrators are devious?, ignorant?, does not mean our doctors , or us patients are!!!!!
And anyway, the response on the phone was not - please motivate - it was - "This procedure is not covered"! So, someone is speaking shit here, and it's not the doctors.
Is the procedure covered or not? That is the question, and the answer is simple - YES / NO.....
And finally, this email from them today, after I had a phone call from someone on Friday also saying much the same, but who I abused verbally to no end. In fact, I'm sure they had to go for treatment after they had called me. The down side of all this is the fact that unlike other service providers who I can choose to either stay with, or not, I have no choice here, it's the employers choice of service provider. What I can tell you is that should my financial situation improve, I will take out my own medical aid cover, and just ignore the fact that my employer has one for me anyway....
Their final response:-
Thank you for your recent contact with Discovery.
Hospital approval
Please accept our sincere apologies for any inconvenience this might have caused you.
Our medical review team has approved your procedure; please send your accounts to us so we can process it.
They did not agree to pay for the credit card charges, but then I didn't really expect they would. But one thing is for certain, I'm going to fuck with their brains at every opportunity from now on . And if I have to call them, I will insist on talking to anyone above the call desk level, as I am now convinced they employ previously disadvantaged, uneducated imbeciles in that position.
It's really such a pain in the arse......
Salagatle!
6 comments:
Sorry to hear about all your discomfort and problems with your insurance co. Fawcett died of anal cancer so she must know a thing or two about rear end pain. How do you even sit to write at the comp? And just for laughs as my father in law would say: Hope you did not fall "behind" in your work.
Wreckless: haemorrhoidless
Sorry for your problems, the medical insurance thing is a world wide problem - dont start me - but look on the bright side now your voice is a few octaves higher you can take over for Michael Jackson ....
Get well soon
Guys, I didn't have the full piles operation, where you get pulled through and have a plug up your bum for 5 days.
I had an external pile - basically a swelling of a vein, external to the bunghole, which they simply cut and drain, so sitting is not an issue - I dont need a round doughnut cushion..... but thanks for the kind words anyway...
Salagatle!
Yeah and after dealing with these fucking idiots those vines is going to pop again. So next time tell them it is recurring because you have to deal with thieves aka Discovery!
By the way, why do you pay credit cards charges?
Fish, I don't know - maybe cause I'm so far in the red it will take me a life time to pay them back, so there will be charges involved. For me the settle in 45 days clause doesn't work bro.
Salagatle!
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