Linmed accused of turning away Transmed patients
Transmed Medical Fund complained that its members are being turned away at the Netcare Linmed Hospital.
General manager for Transmed Medical Fund, Maxie Nel, said the fund have received reports that the above hospital is rejecting Transmed members on a blanket basis without making any attempt to establish if they can admit the patient.
“They are apparently advising members that the hospital is not allowed to admit Transmed members,” said Nel.
Nel requested the hospital to have a discussion around the following:
n Insight into why they are rejecting Transmed patients?
n Enforcement of Netcare’s DSP status for the Private Network Plan and its state overflow status for the State?
n Emphasise availability of Pre-Auth line that can be contacted 24 hours per day to confirm benefit / request Authorisation?
The Netcare Linmed Hospital said that it is not true that members of Transmed Medical Scheme are being rejected by Netcare Linmed Hospital on a blanket basis.
“We have, for example, admitted 11 Transmed patients to our facility in the past month,” said Alan Abrahams, hospital general manager at Netcare Linmed Hospital.
Abrahams stated that it is, however, important to clarify that on certain of the Transmed scheme options, members may only be admitted for conditions that qualify as a prescribed minimum benefit (PMB).
“Members who are on Transnet State-only medical scheme options also require special authorisation from Transmed before they may be admitted to private facilities and these rules are determined by Transmed and not the hospital and we, therefore, encourage Transmed members to familiarise themselves with the rules applicable to their specific scheme option,” added Abrahams.
He said that it is also important to mention that all emergency patients will be seen by a doctor in their emergency department and that if the medical scheme refuses to provide authorisation for the member to be admitted to hospital, they will always stabilise the patient first and only then arrange for transfer to the appropriate network-approved hospital.
“Transmed’s pre-authorisation line is open 24 hours a day and we do contact them to confirm whether the patient may be admitted or not,” said Abrahams.
Fortunately, added Abrahams, the majority of Transmed Medical Scheme members are on options where there is no network arrangement that prohibits them from receiving medical care and being admitted to Netcare Linmed Hospital.
