Can a medical aid refuse a client authorization then pay a government hospital ?
Please advise me…..
I needed a knee operation and my medical aid refused authorization as the plan I am on does not cover knee operations.
I then went and had the operation at Groote Schuur Hospital….a government hospital.
I have no found out that the medical aid paid Groote Schuur for the operation ?
How is that legal ?
Surely they cannot pay a government hospital for the exact same operation that they originally refused authorization for ?
Dear Christopher S, I suggest you immediately bring this discrepancy under the attention of the Council for Medical Scheme’s a statutory body that will investigate your submissions and advise you accordingly. You can Google the contact details and submit your request electronically or possibly telephonically.