Medihelp Medical Scheme

Stay away don't even try to join We pay over R6k a month and if you need to go to the doctor they don't pay if you need to go for a procedure they put your medical aid on hold Why do we pay then for what?????? Nothing

Medihelp's formulary needs serious revision They refuse medications which other medical aids would approve.They take your money and give v little in return.One needs strong legal background to challenge unfair decisions made by Medihelp..Can anyone suggest a mechanism for holding them accountable? They only pay for their own rate for hosp specialist cover which is fraction of the specialist rate. Every thing comes off the savings account. The insured benefits are v little. We end up defending savings at expense of health. Recently they allowing option changes past cut off dates . I think they in some sort of crisis. Their 'benefits" have been curtalied across all packages. At extra cost. Basically a disaster. They need to be reported to CMS. SA MEDICAL AIDS IS ALL ABOUT CASH FLOW. They report healthy reserves, clean audits, regulatory compliance. Yet members are unable to access benefits when they need it. The problem is not about insolvency. It is how medical aids are designed. Most medical aids rely heavily on savings (medical savings accounts) . Which is sold as flexibility. In reality they shift risk from the insurance pool to the member. You pay every month, you fall ill. Your savings are depleted. Suddenly u are uninsured while paying premiums. This is not insurance. It is self funding. Medical aids should maximize care per rand. They collect money and then throttle you. Cynically they approve surgery for obscure conditions eg tongue tie. They have numerous admin staff who are basically being paid ? From our premiums which shifts away from the insurance pool. CMS is ineffectual in holding Medihelp accountable. Why does medihelp not respond on this forum instead of wanting my contact details? Anyway how do I send contact details ? To what address ? If one does outpatient blood tests it wipes out savings leaving nothing for further procedures and tests. I recently asked to escalate my option as I have a serious illness. They did not allow. Can the manager call me ? After my lengthy note, do u know why we still with medihelp? Try and change at advanced age !!! The other medical aids will load !

I have been on CAMAF and Discovery and find that Medihelp far surpasses both of the above in terms of helpfullness and coverage. Each time I contact Medihelp, I am helped..

We have been client with Medihelp for the past 5 years being on the plan we are ones addmited to hospital and after being discharged from the hospital there is no more funds as you then need to pay out of pocket. We even have issues with the pharmacy as our medication never arrives on the same date its always late...

This place is the most pathetic medical aid I have ever been with... We found out my wife was pregnant and since then my issue has started with these people. We immediately tried to gather info regarding home birth and what will be covered and so we then got the hospital authorisation... Then I saw the amount they were to cover and could not understand, so I logged an enquiry... Without any info being given to me they just updated the hospital Authorisation to the max amount they cover for the entire confinement... Now after my wife has given birth, all of a sudden they have a whole bunch of stories about the tariff code only covers a percentage of the entire confinement yet my authorisation states different. Now when I'm trying to claim, and follow up when I can expect payment, all of a sudden I get 3 completely different answers from these people. I'm now busy logging a complaint for medical malpractice at the medical board of South Africa. This is honestly the worst medical aid firm and just because of this pathetic service I would much rather end up in Steve Biko before struggling with a place where I have to pay nearly R8,000-00 to be treated this poorly.

⚠️ Caution Regarding Medihelp ⚠️ Based on my personal experience, I would strongly advise people to be very cautious when considering Medihelp. After being a loyal member for 8 years, I missed one or 2 payments and immediately reached out with a well-explained request for an opportunity to catch up. Instead of understanding or support, I was informed that my membership was terminated. Despite this termination, I was still billed for two months’ contributions during which no service was provided. When I attempted to arrange a payment plan, I was told that it would only be accepted if I submitted documents usually required for a credit application (three months’ payslips, three months’ bank statements, ID copy, and proof of residence). I queried this in writing, but never received a response. Instead, Medihelp escalated the matter to their lawyers, listed me with ITC, and to this day have not rep**** to any of my follow-up emails. It is deeply disappointing that after 8 years of contributions, I was treated in this way. I have since moved over to Discovery, where I have received far better service. Even several medical facilities have mentioned to me that they too experience ongoing issues with Medihelp. I share this so that others can make informed decisions before joining. In my view, the way Medihelp handled this situation was unreasonable and disheartening.

Very Disappointed After Years of Loyalty I’ve been a loyal Medihelp client for years, but my recent experience has left me extremely disappointed. My wife fractured her foot and required a simple medical aid — a moon boot — prescribed by the doctor. Medihelp refused to cover it, saying it must come from my savings, even though this could be classified under PMB. I phoned to question this and was told my plan is “basically a hospital plan with some added benefits and savings (Medd Add),” and that I should “manage my savings better.” I then asked the obvious question: How do you “manage” accidents? Their response did not address the issue, and they still refused payment — not for the doctor, not for the medication, and not for the required medical equipment. It feels like almost everything comes out of my savings (which is essentially my own money), leaving me to wonder what I’m actually paying premiums for. I truly believed my family was in good hands for situations like this. Clearly, I was mistaken. When I asked to cancel my membership, they didn’t even question my decision or try to resolve the issue. The representative simply said she would email the cancellation form and informed me that I still owe them one month’s premium due to a 30-day cancellation notice — meaning I’m paying another month for a service I no longer want or trust. I will definitely be moving to a more reputable and well-known medical aid that supports members when the unexpected happens.

As a dentist I would advise you to stay away from this company. They don't pay their claims and certainly don't attempt to resolve any administrative problem. You will wait for you money for months. From now on I will recommend to all my patients to stay away from medihelp as they are only there to line their own pockets and have absolutely no interest in the patient's health or finances. After several submissions of the same claim it has still not been processed, almost 3 months following the initial claim.

Disappointed in Medihelp, their admin is often not accurate, slow and vague. I pay a R1000 pm penalty (apparently for life, and it's"legal") because I worked overseas, so Medihelp doesn't recognize foreign medical insurance companies, but when I need them I end up paying huge sums of money for things they don't cover fully or on the excuse that my "savings" is depleted. As it is I pay all my medication cash because Medihelp has so much red tape and stories. I was on Medihelp long ago, but now "they can't find" any records . . . Will soon start shopping around for better medical aid.

I am extremely disappointed with the level of service and administrative competence at Medihelp. While I understand the explanation provided regarding the erroneous payment from my medical savings account, it is frankly unacceptable that Medihelp now expects me, the client, to carry the financial burden of their own admitted mistake. Let’s be clear: this was not a misunderstanding on my part — Medihelp processed a payment in error, and now, instead of taking accountability, they are demanding repayment from me for a transaction they mishandled. The fact that they acknowledge the mistake and still push the liability onto their client is not just poor service, it’s outrageous. Sadly, this is not the first time I’ve experienced Medihelp’s administrative incompetence. Each time, it’s the client who is left to pick up the pieces and fight through red tape to get clarity or justice. A medical aid provider should be a source of support and reliability, not a constant cause of frustration and mistrust. Medihelp needs to take a hard look at their internal systems and processes. Until then, I cannot in good faith recommend them to anyone looking for a trustworthy and client-centred medical aid provider.