AG
AYSHA G

1 reviews | Active since Dec 2010

26 Apr 2019, 16:36

9000k paid to medshield monthly for 2 ppl and benefits keep reducing

My folks are in their late 70's. We pay R8787 per month for their medical aid with Medshield. Neither one of them had lengthy hospital stays within any hospital in the last two years - my dad was hospitalized last year for a day or so for cardiac issues - irregular heart rates. This is a massive amount of money to pay for 2 people's medical aid, but we made the decision years ago to keep them on a premium plan due to their advanced age and health issues. My father is a chronic diabetic with many health issues stemming from his diabetes. Medshield has always had a partnership with the diabetic clinic in Johannesburg. Medshield would pay the diabetic clinic a certain amount every month (R2550) and my dad would visit he clinic - see all the doctors there, have his blood tests done there, and also collect his diabetic related medication (insulin, glucose machine strips etc). Yesterday, my mom aged 75 takes her wheelchair bound husband out in pouring rain for his appointment at the centre for diabetes. They saw the doctors as per usual, but when they went to go and collect the insulin etc they were told their medical aid no longer has a partnership with the centre for diabetes! So my questions are: 1) From where are those doctors consultations going to be paid? They have limited day to day and it ALWAYS finishes way too quickly 2)We were told telephonically to go get his insulin from Dischem which we did, but they refused to give us the glucose strips for diabetic test readings and said to take it up with the medical aid? Where must his diabetes related meds come from and very IMPORTANTLY HOW DOES THIS AFFECT HIS DAY TO DAY ALLOCATION FOR THE YEAR? 3) Which doctors must he now see and how will they get paid, and how will this affect his day to day allocation? 4) Why was no communication sent to us about this extremely important change and a way forward explained? 5) My father's cardiac med dosage "sota hexal" was increased from 30mg to 90mg months ago due to the fact that he was hospitalized for cardiac issues. Since then, when the meds are given to us a R70 co-payment has to be paid, even though this is a chronic PMB condition? Not to mention the fact that we pay nearly R9000 per month for their medical aid for 2 people - not even a family. 6) My mom is a cancer patient since 2010. Yet last year and this year, her oncology treatment is not in her PMB plan. Why? Is this 75 year old cancer patient supposed to do the admin between the doctor and the medical scheme to get this done? Shame on you. Your excuse is always that you haven't received a plan from the doctor! So get it?

Again - we are paying nearly R9000 and there are always co-payments and the benefits are consistently decreasing? When PMB conditions are never treated as such and theres always payments? Where's the communication regarding critical changes? We need answers.

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Replies (2)
Medshield
Medshield's reply29 Apr 2019, 07:10
Official
 
Good day,

Medshield Medical Scheme has acknowledged your complaint and is currently investigating. 
Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days. 
 
Yours sincerely, 
Medshield 
Medshield
Medshield's reply03 May 2019, 14:46
Official
Good day 
 
With reference to your complaint received at the Scheme. 260419QDJ9ST

Upon the investigation we can advise as follow.

With regard the diabetic clinic , please note that communication was sent to members on the 25/*** and for the member in querying it was sent to the following email address *** .However, member may continue consulting with CDE doctors but they will no longer dispensing  medication.

In addition to that, please note that consultation will be paid from day to day benefits , once day to day benefits has been depleted it will be payable from care template for chronic benefits as per authorised by the scheme. Furthermore, it should be noted that chronic medication should be dispensed by Medshield pharmacy network and claims will payable  from chronic medication benefits .
 
As discussed telephonically , please be advised that as per our record sota hexal medication is approved for 60 quantity , however, we have noticed that pharmacy is claiming 90 ,hence there is a co-payment. It should be noted that an updated script need to be sent to our chronic department for further assistance. We can also confirmed that we have been liaising with our chronic medicine management with regard the glucose strips for Mr Gani and they have advised that they are not registered on his chronic medication table , scrip is required for registration. 

Lastly we can advise that 2019 oncology authorisation for Mrs Gani has been loaded and authorisation number is ***7.
 
We trust you find the above in order.
 
Yours sincerely, 
Medshield