MS
Mixo S

1 reviews | Active since Mar 2017

14 Jun 2019, 17:48

Authorisation provided but claim rejected

How do you guys give an authorization to later on reject a claim?

I provided you with a referral letter from my GP on record to a psychologist (using the specialist benefit) where i get 1 specialist consultation provided i be referred and subject to your authorisation. And you provided me with an authorisation number. And I do not know which bus Arief (team leader) fell off from but my word listening is a s****.

There is no such thing as you guys providing an authorisation for something you do not cover. I didnt go outside of the parameters of the authorization so on what grounds is it now no longer applicable and being rejected?

In the authorization it was stipulated whom I'm referred to (psychologist) and if you guys feel like its not a specialist why did you approve the authorization? So how is it that now when its time to pay the claim its an issue?

It is not my fault that your authorisation department didnt provide complete information.

What i want now is for the claim to be processed and psychologist be paid as per the 1 consultation of a specialist benefit. And i want the confirmation asap or i am taking this case to the ombudsman.

0
Replies (1)
Medshield
Medshield's reply18 Jun 2019, 07:25
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