|BRANCH / AREA||authorisation||COUNTRY||South Africa|
|TIME / DATE||07:00 Thu 7 Mar||PERSON RESPONSIBLE||authorisations|
|CUSTOMER||YB260380||View all reports by user||
delayed and incorrect ...
|INCIDENT||Tue 5 Mar|
delayed and incorrect authorisation
|I went to my GP which then refered me to Cardiologist in Bfn. I phoned Nazeem in call centre on the 25/02/2013 explaining that I need to get an angiogram done and specialist said 1 day for auth and gp said 3 days. He explained it would take 4 days and I that the dr forwarded the keycare form aswell as form from cardiologist with icd 10 codes, description of procedure and that I would be admitted to perform procedure. 3 days later I got authorisation and since my appointment had to be rescheduled form 26 Feb to the 5th Mrt due to delay in auth I went to Bfn Mediclinic at 06:00 for procedure only to hear they cant help they are not a keycare provider even though I got auth. The dr made plans got me transfered to hosp and dr in keycare option but now I had to get new auth as the auth I had was only for specialist visit and not the procedure. Auth center only opend 08:30 and I had to wait 2 hours. Got to see specialis and he wanted to admit me for the angiogram but we still could not get auth. Who is compensating me for travel expenses and loss of income? call ref nr, anneke 2756020097, monica 2756207987, very rude shawn2756486994 had to return home wihtout anything done which is200km|
|SUPPLIER'S RESPONSE||Discovery Health||Time and Date||15:15:49 | Fri 8 Mar 13|
Thank you for your comment.
I have been trying to contact you telephonically, however have not been able to reach you.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there was any pre-existing conditions of which we were not aware.
After receiving your request for hospital admission we pended your authorisation as we needed the above mentioned clinical information. We faxed this request to your provider on 5 March 2013. We are still waiting for the requested information in order to continue with your authorisation.
I confirm that I have emailed you detailed feedback in this regard.
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