Business / Companies
Client clashes with PSMAS
25 May 2018 at 10:35hrs | Views
A client at Premier Services Medical Aid Society (PSMAS) has accused the state health insurer of foul play amid allegations that the institution has failed to refund him over $800 which he used to cover his medical expenses after the institution dismissed the bill sent to the health insurer for refund as "too much".
The client said the health insurer is no longer of assistance at its centres and has adopted a habit of sending them to specific doctors who are suspected to be pushing a scandalous side business together with the health insurer.
"I contribute $15 monthly to PSMAS but each time I need medical attention I still have to struggle to get cash to see a doctor."
He said the medical aid society owes him over $1 000 refund which he paid when he went for a jaw operation when he got injured while at work.
Mid 2016 health service providers vowed not to accept any medical aid after the Zimbabwe Medical Association (ZIMA) claimed to be owed more that $220 million in unpaid claims by Medical Aid Associations.
The impasse between the health funders and health service providers has sparked confusion among members of the public who are on medical aid as they are now paying double for a single service.
Contacted for comment, PSMAS public relations officer, Arthur Choga said the case is isolated and be a result of miscommunication as there are certain procedures that go on in medical aid funds.
"If somebody needs to have medical attention or procedure done, they get proforma invoices from their doctor showing how much the total procedure will cost and the medical aid breaks down the figure and pays a certain amount of the total cost and not all of it.
In the past few months we have had a few to no such cases of refund and this case must be an isolated one that we are going to deal with."
The client said the health insurer is no longer of assistance at its centres and has adopted a habit of sending them to specific doctors who are suspected to be pushing a scandalous side business together with the health insurer.
"I contribute $15 monthly to PSMAS but each time I need medical attention I still have to struggle to get cash to see a doctor."
He said the medical aid society owes him over $1 000 refund which he paid when he went for a jaw operation when he got injured while at work.
Mid 2016 health service providers vowed not to accept any medical aid after the Zimbabwe Medical Association (ZIMA) claimed to be owed more that $220 million in unpaid claims by Medical Aid Associations.
The impasse between the health funders and health service providers has sparked confusion among members of the public who are on medical aid as they are now paying double for a single service.
Contacted for comment, PSMAS public relations officer, Arthur Choga said the case is isolated and be a result of miscommunication as there are certain procedures that go on in medical aid funds.
"If somebody needs to have medical attention or procedure done, they get proforma invoices from their doctor showing how much the total procedure will cost and the medical aid breaks down the figure and pays a certain amount of the total cost and not all of it.
In the past few months we have had a few to no such cases of refund and this case must be an isolated one that we are going to deal with."
Source - Byo24News
