FedHealth.co.za / Fedhealth Medical Aid
Reviews and Complaints

Fedhealth - The empty promises
In November 2011, I signed up with Fedhealth medical aid scheme after having received information from a broker from Direct Axis. He strongly recommended Fedhealth because according to him, Fedhealth paid for visits to ER, and since I have 2 young children he recommended this medical aid scheme because of this feature.
On 04 Jan 2012, my toddler swallowed something and was chocking. I was afraid that the object was lodged in his windpipe or might become lodged in his digestive system. Because of the 3 month waiting period that I knew was in place, I telephoned Fedhealth to find out whether a visit to ER (Rondesbosch Medical Centre) would be covered. I explained what had happen. I asked whether I could take my son to ER. I was told that it would be covered, and so, I took him to ER. Some weeks later I was contacted by staff from Rondebosch Medical Centre, and was informed that my medical aid was refusing to pay any of the bills. When I contacted the medical aid, I was told that they would not pay because I had failed to get an authorisation number from them. I was surprised, because I had thought that my phone call to them on 04 Jan, to find out whether they would cover the visit was, in fact, me getting authorisation
Anyway, I accepted their reason. On 27 April 2012, which was a public holiday, I hurt my foot (suspected fracture) and needed to go to ER. Because of my previous experience, I made sure to call Fedhealth to get an authorisation number before my visit, but because it was after hours, I only got through to their automated system. I left my info on their automated system, and on the very next working day, I used their email facility to get the authorisation number. I received no feedback, so I telephoned them again. I was told that they had received my request, as well as, the claim/bill from ER…and that they had sent this information/claim to their underwriters. I was very surprised, I couldn’t understand why a simple accidental fracture would need to be assessed by their underwriters, and after all, I had been told that all ER visits would be paid.
The following is what they claim on their website “Emergency treatment in casualty wards …General radiology will also be paid from the In-Hospital Benefit if it is part of the treatment in the casualty ward.”
As per their usual style, no one bother to get back to me as promised. I called again; I was eventually told that they would not be paying my claim because I had “insufficient funds”. Now this I didn’t get, I didn’t have a savings option with them, just a basic hospital plan and I pay my contributions on time…and I had been told when I signed-up with Fedhealth that ER visits would be covered, and according to their website, Fedhealth should have at least paid for the X-rays that I had in ER. When I asked for an explanation, I was told that they would only pay for the ER visit, if it was immediately followed by an admission to hospital.
Be that as it may, I still believe that according to their assertions (on their website) they should have at least paid for the x-rays, but they refused. What I don’t understand, if the reason for declining to pay the claim was supposedly so straight-forward (i.e. “insufficient funds”); why did my claim have to be sent to their underwriters for assessment? It seems to me that Fedhealth doesn’t know how their various medical aid options work; or they are just searching for an excuse not to pay. All I can say to anyone considering to join Fedhealth, please don’t…I’ve submitted 3 claims and all have been declined for some or other reason. In my opinion, Fedhealth will happily take your monthly premium, but don’t expect them to pay out when you submit a claim.

Don't let these corporates take advantage of you... Fight back! I did & won my small claims court case against fedhealth medical scheme for not wanting to pay for the birth of my daughter. When the medical obudsman even told me that "I should speak to the president if I have a problem", I wasn't too convinced that the justice system would come through for me... But guess what... They did! I've joined a medical insurer now & I cannot tell you how happy I am about their service, integrity & ethical manner in which they treat me (Unlike fedhealth). If you belong to any medical aid, especially fedhealth medical scheme, I suggest you re-eveluate your options & find out exactly what you are covered for.
I even received the baby bag & goods, only for them to turn around a month before the birth to say that they will not pay! The ceo, katy caldis, was too lazy to appear herself (Which already says alot about their service) & sent someone who had absolutely no idea about the case. Md, kevin aaron, also too busy to even respond to your communication to him & I hope that if you belong to the scheme, that you will heed my call & "get out!". They paid me a day after the verdict, so goes to show that they will have to adhere to the courts decision & for those who don't know... They cannot have legal representation in the small claims court! Take them on face-to-face (If they're "man" enough... Unlike fedhealth!)

In short, if you're being wronged & you have a solid case against any big corporate... Take them on! The justice system is great & now that the small claims court have increase the claim limit from r7000 to r12 000... What do you have to lose!

Go get'em south africa!

Fedhealth is not to be trusted. I have had a query with them since 6 January 2010. They unilaterally canceled my bank account details saying I put a stop at the bank, which my bank conforms is a blatant LIE, as FEDHEALTH did not present a debit order on my account.

All my efforts to submit claims have been frustrated since 6 January, where they no only currently suspended my benefit again for payments not made (AFTER I they were the one's who incorrectly canceled my details in the first place, I told them to reinstate it from January already, which shows that it was done to late to go through in MARCH!).

I have outstanding claims amounting to thousands of rands which I had to pay cash because of their mistake, and now that I am claiming for my money back, they coming up with all excuses to not pay me. It's either they did not receive my claims (I have emailed proof thereof) or the scans are coming through too light (ZOOM - darken image at printer!). I called on Thursday to speak to a manager at around 15h00. I am STILL awaiting a call from someone from Fedhealth to call me.

They're a useless bunch of incompetent buck-passers who are ripping people off!

First of all your response to my report is incorrect of what transpired since my cancellation. I never received electronic communication advising me of my payment contribution not honored nor that I will be terminated due to non payment or back dating my termination date and advising that you will reverse claims paid. I did request a copy of such notification if it exists. I have not recived a copy of such notification. The membership guide you are reffering to, I did not receive or recall reading, I would have expected you to advise me of that condition the day I spoke to you lady on the phone, you have a copy of the voice recording please listen to it, It was never communicated to me on that day. You poor communication meant I was not covered for a month due to the fact that you terminated me without my concent, I see this as grossly negligent on your behalf and the fact that you reversed claims paid to providers. What you also fail to admit in your response is that I did pay you but you returned my payment. I have requested that you revert the matter to an independent dispute committee.

I joined Fedhealth as from 1 October 2009 as a dependent as I was not happy with my previous medical aid (I was on my previous medical aid for 2 years and 8 months). Since joining I have not yet had a pleasant experience!

I received my member certificate on 1 October 2009 and it had a 3 month exclusion clause on there. I enquired as to the reason for this and what it entails. I did not get any response and therefore phoned the call centre on Tuesday 6 October 2009 at 16:35 and spoke to a lady that told me the exclusion is only for hospital visits where it is not an emergency. She told me I could visit a doctor or dentist etc and I specifically asked if my Yasmin prescription will be covered yet. She said yes, as from 1 OCTOBER 2009 I will be able to get this from any pharmacy.

The very next day Mojalefa Maega eventualy responds to my email, saying the complete opposite from the lady at the call centre. Stating my Yasmin is only covered after 3 months. I asked for a reason for the inconsistency, still no response!

When I tried to buy Yasmin at the pharmacy I was told it is not covered!

I find this company very unreliable to be taken for its word because everytime I phone the call centre for a request, the response I get is always changing and conflicting - depending on the agent I speak to. Fedhealth is openly not passionate about clients, they seem to only pray and wish that you constantly enrich their pockets by paying premiums and NEVER get sick or if at all you do, they hope you go to a public hospital.

The last time I was admitted to the hospital and I needed a MRI scan, they delayed any authorization until I called in from my sick bed to beg them to approve. They even queried my blood pressure state to make sure I wasn't in DIRE NEED OF A VACATION IN A HOSPITAL by pretending to be sick.

Now my problem is that I got chronic medication from my doc and when I sent it through they refused to put in 2 of the main medications I needed but instead they added Disprin at free will, since it only cost R15. Then I called to enquire after 2 months they responsed that they will call my Doc and ask him reason for giving the medication...First it was BP and now medication...Then I am asking myself what really is the value of being a member of this scheme.

On the 10th of June 2009, the main member was hospitalised. The hospital will not admit a patient without full payment being made up front for which a credit card transaction was made. When contacted, the medical aid indicated that the amount was fully refundable. Documentation was sent as requested and the medical aid on the 13th of August finally made payment - not to the claimant but to the hospital (AGAIN!). Get the money back - of course not. We have been told to start the process again by submitting the paperwork again.

Of course trying to call on the customer care service number is nigh impossible - engaged tone can be heard for up to an hour at a time!

We wanted to move my wife from Fedhealth to Discovery as my employer pays a considerable contribution to Discovery.
Now, due mistake on our part we will be paying for my wife c-section in cash (Total bill R 31 000).
FYI : family of 4 on 1 salary
What happened : My boy was born in July in Centurion. We wanted to cancel with Fedhealth as soon as possible and we made the BIG, HUGE, GIGANTIC mistake of putting the cancellation request through at the beginning of Aug (thinking that contributions are paid a month in advance). This effectively puts our last date of being a Fedhealth member at end of June (NOT END OF JULY).
What happened next:A lot of phone calls explaining and begging them to pay they C-section as we are willing to pay the contribution of July.
They said the following : 'The enquiry related to your claims and termination of membership was presented to our fund manager to consider payment of claims related to your caesarean section if the contribution amount for July 2010 would have been paid. It is with regret to inform you that your enquiry has been declined andwe have attended to your enquiry correctly and in line with scheme rules.

Thanks Fedhealth, you saved money !