Focus on their own needs at the core of Momentum Health in 2015
Medical aids of today has come a long way from the old days where they just paid for your medical expenses. Today there is a huge focus on healthy living and preventative behaviour that all gets linked to fancy rewards schemes to motivate the members to engage in healthy living practises. They advise you to go for pre-screening for just about every condition possible from regular blood pressure tests to prostate check-ups and a whole long list more.
It came as a huge shock to me then, when I requested admission to a rehabilitation facility for a long standing drug addiction, that they declined the authorisation.
I should start by giving all the facts. I use to work in the financial industry and was a member of Bankmed for about 9 years up until 2010. At that time I lost my job as a result of my addiction. Oh, the work never new about my addiction, but my quality of work had deteriorated to a point where I was a liability to the company and hence they let me go. Then around middle of 2014 my partner got very ill and had to stay in hospital for more than a month and I realized that we can’t be without a medical aid started looking for a new medical aid. Due to the fact that Bankmed is a subsidiary of Momentum Health I decided to join them.
All the contracts were signed in middle September 2014 and the first premium deducted on 1 October 2014. Then during the festive season I engaged in very risky sexual behaviour whilst I was under the influence and had a HIV scare. To my great relief the second test came back negative, but it made me reflect on my live and my 15 year addiction to crystal meth. I decided that I need to make a change as my life was slipping away slowly whilst I was high every single day.
I immediately started looking into treatment facilities for drug addiction and after long deliberation decided on a facility that had a good reputation and was reasonably priced. The total cost would fall well within my benefit that Momentum Health said I have. To my great surprise the clinic phoned me this morning to advise me that the authorisation request has been rejected. The reason was because I have not been a member of the medical aid for 12 months.
I immediately got onto the phone to speak to Momentum because surely this is a mistake or misunderstanding of some sort. The call centre referred me to Ms Saksha who according to them is the person who deals with this type of authorization. Explaining to her my long history of addiction (15 years) and my close call of last year that lead to the decision to kick this destructive habit, I was shocked to just get a cold shoulder on the other side of the phone. I was told that the condition was pre-existing and if I had declared it on the application they would have excluded it for 12 months so they will not authorize it before October this year.
I was totally blown away. So Momentum would rather let me risk my life for another 7 months taking this destructive drug than approve a benefit that is part of the policy I am paying for every month? What has all of a sudden happened to healthy living and preventative behaviour? How much does Momentum really care about their members when “company policy” as she put it take precedence of somebodies health? Are all these healthy living schemes got anything to do with the members or is it all just there to try and increase the medical aid’s profits?
According to a Media Launch in September 2014
Focus on client needs at the core of Momentum Health in 2015
I beg to differ!