BEYOND COMPREHENSIBLE

<p>I WOULD LIKE TO GET STRAIGHT TO IT FIRST OF ALL THE DR MADE A REQUEST FOR CLOPIWIN PLUS </p> <p>TO BE APPROVED AS PMB FUNDING. THE SCHEME ONLY APPROVED THE MEDICATION FOR SIX MONTHS HOWEVER THE DR SAYS ACCORDING TO THE REGULATION OF CARDIOLOGY DUE TO THE PATIENT BEING AN UNSTABLE ANGINA PATIENT WITH 2 STENT INCESIONS AND CLOTING RISK FACTORS SHE SHOULD CONTINUE THE MEDICATION FOR A FURTHER 6 MONTHS. THE MEDICATION IS REGISTERED UNDER A PMB ICD 10 CODE. I FUND IT FUNNY THAT THE SCHEME DOES NOT WANT TO APPROVE MEDICATION THAT WOULD COST +- R1200 FOR 6 MONTH RATHER THEN HAVING THE PATIENT SUFFER I MEDICAL SET BACK THAT WOULD REQUIRE HOSPITILIZTION THE DR HAS SUBMITTED THE PMB REQUEST WITH MOTIVATION AND PREVIOUS CARDIAC REPORTS. WE ARE NOT REQUESTING ONGOING TREATMENT RATHER ONLY SIX MONTHS. I HAVE SPOKEN TO THE SCHEMES CONSULTANTS WHO WERE IN A DAZE REGARDING THIS MEDICATION SO LIKE I SAID WE ARE MADE TO SPEAK TO *********** CONSULTANTS. </p> <p> </p> <p>SECONDLY I RECIEVED AN EMAIL REGADING THE VISIT OF DR VISAGIE FOR THE 03/0517 THE SCHEME INFORMED US THAT THE WILL REVERSE SOME PROCEDURE CODED TO FUND AS PMB AND REIMBURSE NOW I ASK DUE TO THE FACT THAT THE SCHEME DID NOT PROVIDE ADEQUTE INFORMATION. WILL THE REIMBERSE THE DAY TO DAY BENEFIT BECAUSE IT EAS PAID FROM THERE. OR IS THIS A SUBLIMIT ISSUE THAT WILL YIELD THE SAME RESULT THAN WHY REVERSE OR REIMBERSE THE CORRECT LIMITS. FURTHER EXPLAINATION. </p> <p> </p> <p>THIRDLY </p> <p>THE SCHEME INFORMED ME THAT I SHOUL FOLLOW PROPER COMPLAINT PROCEDURES I AM SICK OF CALLING THE CALL CENTRE AND SPEAKING TO A CONSULTANT JUST SAY SEND A EMail to the SCHEME THEY WILL EXPLAIN THEN I SEND THE EMAIL AND I GET A RESPONSE AFTER 3-4 DAYS THEY DO NOT CONTACT THE MEMBER TO INQURE IF THE MATTER HAS BEEN PROPERLY ADDRESSES THUS FORCEING ME TO EMAIL THE COMPLAINTS DEPARTMENT AND INVOLVING THE CMS. I DEAL WITH OTHER LEADING SCHEMES AND I DO NOT EXPERIENCE SUCH POOR CUSTOMER SERVICE. MEDSIELD DOES NOT HAVE STATION MANAGERS NOR TEAM LEADERS THAT ARE CONSULTED WHEN SOMETHING IS NOT CLEAR. </p> <p> </p> <p>THANK YOU </p>