Dreadful preauthorisation procedure

Dear Sir or Madam: My mum was scheduled for surgery on the 29th of August 17 with Dr. Stallenberg (Neuro Surgeon) who had informed us that if my mum does not have the surgery she will loose the use of her arm eventually. Documentation for authorization was sent via the doctors rooms, we were then informed that a physiothe****** report was needed on the 22nd of August. The report had been completed and sent through on the 24th (As an appointment was needed to see the physiothe******). On Monday the 28th I had called the doctors rooms to inquire the response received, and was informed that no response was received. I then decided to call the Medical Aid myself to determine the progress of the authorization. Upon calling the call centre (at 9am) I was advise that due to high call volumes, no one could assist me, and that I will be contacted shortly. I waited for an hour, and received no call back. I then called back again and was advise that the file was with the medical advisor( Who is just a GP and not a neurosurgeon) and they are awaiting feedback, which the expect by 12 o clock. I then received a call from the doctors rooms (at about half past 1) to be informed that the authorization has been declined.

I then called the Medical aid to inquire why the authorization was declined. The lady who answered the call at pre authorization department, again advised that she was unable to assist me and someone will call me back. I was enraged at this point and insisted on holding on until someone was able to assist. She then took my details down and got an agent up on the process, she then came back and informed me that the file was still sitting with the medical advisor. I was abit confused at this point as we were informed that the authorization was declined, so why was the file still sitting with the medical advisor, and why could they not give me a reason as to why the authorization was declined. Whilst on the phone, someone from the medical aid called my cell to inform me of the progress.

The lady advised that the authorization was declined due to the fact that they could not use the physioreport as they could not read it, and that they had attempted to contact the physiothe****** numerous times but her phone was unreachable. I was then confused and contacted the physiothe****** to determine why she had not taken their call, and was told that she had received no calls from the medical aid, nor was there miscalls on her phone. I even offered to resend them the report as I had a clear copy of this, but was told no they need to speak to the physiothe******.

I then contacted the lady back and informed her of this, she was adamant that my mum should continue going for physio instead of surgery and that they would make the appointment for her to go for physio and contact us with the details. I then insisted that they contact the physiothe****** before declining the auth and wasting my mums time going for physio as it just causes her more pain and discomfort. The lady took the number down, but again never attempted to call the physiothe****** as she again confirmed that there was no call from the medical aid. The lady then insisted that the only other option was physiotherapy, of which they would make the appointment and contact us regarding the details, which I haven’t received yet.

So my question is, what on earth am I paying so much for medical aid for as they are not able to provide us with services. And why would their medical advisor be a GP, when the doctor who is performing the surgery is a Neurosurgeon, surely they both have different qualifications suited to perform their jobs, and the neurosurgeon would have greater knowledge with regards to the procedure, as that is what they specialize in. So surely the Neurosurgeon would not recommend a surgery that his patient does not need.

Medshield has really provided pathetic service. I am really disappointed with the way the case was handled. They need to carry themselves out as a professional body. Their customer service stinks. Most people who answer the phone is unable to assist and the supervisor is always unavailable. I truly hope that no one else has had to go through this dreadful process with them.