My mom was in hospital in ICU. The Medic...

Asked by BigEd777 on 09-08-2016 11:41:08
Question posted in the General Law category relating to Gauteng
Question value: R 250.00

My mom was in hospital in ICU. The Medical Aid will not pay the hospital for the ICU fees. All other hospital expenses were paid. The Medical Aid will pay if a letter from the Doctor is given to substantiate why ICU was necessary. The hospital and I have been trying to get this letter from the Doctor since Feb 2016. The hospital have given the account (R50000.00) to debtor collectors /attorneys. I have had a meeting with the hospital head of finances. Telephone calls to credit controller at hospital. Spoke to receptionist/?? at Doctors rooms. Many e-mails to hospital and Doctor. No response and no letter. I am concerned that the Medical Aid will not pay as this has been dragging on since Feb 2016. What can I do to get this resolved. How can I get the Doctor to supply the letter. Is there a ombudsman / medical council ?? that can assist? Do I get a lawyer to write a letter to the Doctor? Many thanks

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Answer to the Question

Posted by Att. Patrick on 09-08-2016 22:26:06
Hi there and thank you for your question,

Unfortunately the only way to proceed in this matter is to get the doctor to provide you with the requested letter.

One way to go about it is to write a formal legal letter to the doctor really setting out the following: (1) he admitted your mother into ICU; (2) you have submitted all of the hospital bills (including the ICU account) to your mom's medical aid, and the ICU portion was rejected; (3) the medical aid has requested a letter from you (the doctor) requesting information as to why ICU was necessary; (4) you have requested such a letter from him on numerous occassions, and to date he has failed to let you have such a letter; (5) if he does not provide you with a letter, the hospital will sue you for R50,000, and you'll need to pay it since your mom's medical aid won't cover it; (6) accordingly, without the doctor's letter, you will be "out of pocket" by R50,000; (7) his negligence, and/or refusal to provide such a letter is having a massive financial impact on you/your mom to the tune of R50,000; (8) if he doesn't give you the letter within 4 working days, you will join him as a third party to any litigation which the hospital institutes against you/your mom for payment of the R50,000.

Add in at the end that you don't understand why he won't just give you the letter, as it will finalise this issue.

The purpose of the letter is to create the FIRM link for the doctor that his failure to give you the letter will essentially cost you R50,000, and that if the hospital sues you then you will sue the doctor for the R50,000.

You should maybe give a copy of the letter to the hospital's lawyers, and keep them informed of what is happening.

Make sure that you hand deliver the letter to the doctor's rooms and have the receptionist sign for it, or get her name as acknowledgment of receipt.

You could also give a copy of the letter to the hospital.

You could also give a copy of the letter to the Health Professions Council of South Africa ( or lodge a complaint against the doctor with the HPCSA. Maybe that might get something happening...

If there is a part of the answer which you need more advice on, or clarity please continue in this same thread instead of opening a new question.

Att. Patrick

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