Oh! Susanna, [the fall guy for a local medical practice]
I’m having a particularly bad hair day today. To wit, your final demand refers.
I don’t have any gripes with NHP medical aid’s junior front-desk staff unable to deal with the bigger picture pissing me off — just one more “friendly” non-profit medical aid association using clever (exploitative) tricks to make eye-watering amounts of money (thanks largely to the underlying greed of the medical ‘profession’ and pharmaceutical monopolies in general) — by making a *distinction* between ‘outside’ and ‘inside’ hospital (emergency) room treatment, and therefore requiring *admittance* to ensure the medical aid scheme’s hospital plan cover will finance the treatment of potentially serious medical conditions!
No. I don’t.
I’m annoyed by the manner in which medical aid administrators deal with claims against its membership by medical ‘practitioners’ such as yourselves.
Since you’re highly unlikely to know the circumstance, let me try to explain. We returned from a trip to the lowveld of eastern South Africa some two weeks priorly, and while there were some initial flu-like symptoms on Monday 16th and Tuesday 17th January, these escalated to high fever and other seemingly malaria-like symptoms by the evening of the 17th. This prompted a decision to go to the emergency room at your clinic for malaria testing that same evening. We’ve had bad experiences with malaria in the past, and our regular family GP was not available to provide a service at that stage.
While there, your attending medical staff returned with blood results (done by pathcare?) which were negative for malaria but apparently diagnosed to have a high (indeterminate and suspect) infection count apparently requiring admittance for an overnight *antibiotic* IV treatment. Hence the IV cost item on your invoice.
This is where things apparently got ballsed-up by yourselves –
1. Your medical staff in attendance failed to request a pre-authorization from the NHP scheme for this IV antibiotic treatment/admittance. This would have probably solved the present problem in the first place, and possibly also helped to substantiate the medical diagnosis requiring such treatment and admittance.
2. You subsequently chose to bill me with (inflated) tariffs for emergency room attention and consultation – as a NHP *gold* member – this mistake is reflected on your invoice. My NHP card – presented on the occasion – clearly shows NHP HOSPITAL membership. This is simply lazy accounting.
3. Your subsequent invoice suggests that I had “run out of benefits in my medical savings account”. This allegation is obviously the result of some more lazy accounting on your and probably NHP’s part.
4. I responded to this allegation by email to NHP since I had not used my NHP hospital plan membership for ANY claims for several years!
5. I am still waiting for any kind of *human* response from the NHP administration concerning this issue.
Using robotic, automated SMS and electronic mail responses to avoid direct human engagement (concerning disputed claims) with its membership is symptomatic of a disinterested, exploitative financial industry seemingly suspicious of their members’ motives. This, I believe, is the underlying implication of NHP administration’s *non-response* to my earlier query (31 March 2017 query number: 3103************) concerning your invoice for N$703.
Further, the use of a stereotyped ‘disclaimer’ allowing NHP administrator decisions to reject claims without subsequent notification, let alone explanation, to their members, further aggravates this condition. While my present protestation will likely fall on deaf (human) ears again, I do reserve my common-law rights to human attention, and insist this is an *open* communication. Without prejudice.