Embarrassed and Traumatised by my experience with Medshield

Hello Peter

I need to query something that has become a huge concern, regarding (Medshield) Medical Aid.

My wife started having knee pains, and we later found out that she needed to go for surgery.

Just having to go to hospital for surgery is stressful enough, and (Medshield) has just made so much more traumatizing and stressful.

Due to their actions … We have been embarrassed, and traumatized beyond words, and financially strained beyond anything we have ever experienced before. This has really affected my wife, and the rest of the family as well.

Here below, is the events we went through and the traumatic experience we have had to endure.

She had a very painful a knee pain and on visiting her doctor, we were told get X-ray and sonar scan to see what the issue was. Only later to discover, she now needs a small “same day” surgery on the knee. A small cartilage cleanup Operation called “Arthroscopic Procedures “which is clearly show to be covered on the scheme brochure.

The Doctor sent the codes to medical aid, and it returns via email, showing we had received the authorization codes, and authorization number for the operation.

We believed we had at least some medical aid cover on this as it is clearly Indicated on the brochure scheme as covered.

The Thursday is the operation.

After the operation, as she is recovering on the hospital bed, the reception lady brings her the hospital bill, and in front of everyone in the recovery room, says that the medical aid (Medshield) has now decided, to declined everything! Even the codes that they had approved earlier. ??? My wife is in a deep state of shock, and traumatized even more, then she said that we must settle the hospital bill of R24-516.00 before she can leave the hospital.

Shocking and stressful events for anyone to endure. We managed to get just enough funds together to pay the hospital portion of the bill. We are now, still left with the doctor’s portion of R17-000 still to settle and the anesthetist.

When we then enquired with (Medshield) over the phone.

We are then, simply told that the sonar scan that she had done a week ago, had showed small trace of arthritis and therefore, everything will be now declined because of that?

So, in short, because your body developed something that happens naturally, as you get older, which in this case was arthritis.

(Medshield) then decides to declare your all your medical aid cover as null and void? Shocked and certainly not satisfied with this kind of reply and treatment. We then went to the head office building in Kent Street to enquire directly.

They told us they would “investigate”, and the supervisor told us they would get back to us in two days’ time. Two days later, nothing happens, no emails or phone calls. So then, we decided to leave it for a week. To be fair and let them have time to “investigate “the matter properly. However, sadly, a whole week later still no phone calls or emails. Hmm… Perhaps as paying clients, we were expecting too much. My wife then spends the whole day trying to get hold of the supervisor, leaving messages and still no reply no luck for that whole day.

Only the following day she called and asking if we were looking for her????

A bit later, in conversation with the supervisor, we find out, nothing has changed. Nothing has been resolved. Nothing had been done. No Feedback, no follow up calls, nothing!!!

Therefore, as you can imagine, I am very shocked and very angry, and now very concerned as well. And still do not have the answers to questions regarding all of this.

1) Why were there some approvals and then a total declined on all the codes, after the operation? 2) On the brochure, on page seven. It shows that the procedure my wife went for by name, and that it is covered, by the plan she took. The brochure even shows, that we would just have a R4000-00 co-payment.

Clearly, this was not honored by med-shield, as we now had pay the full 100%. 3) We cannot see/find any mention on the brochure that shows us that Arthritis will render any claims null and void. Not even on Page 7 where it shows we are covered by the procedure that was given to my wife.

4) Why we were not informed that Arthritis, will render all our claims null and void on the very day we signed up for this medical aid?

Let us explain it this way, to get my question across more clearly. If Arthritis has a huge effect on our medical aid claims, why is it not clearly shown on the forms when you sign up i.e., as they do with HIV/Aids status section?

5) The operation was clearly a Cartilage procedure, not on Arthritis issue. As shown and indicated by the procedure name and medical description. So why is it declined? Even though we have cover for this procedure.

We even have a motivational letter from the surgeon, stating that the surgery was NOT arthritis related.

After all this trauma and shocking experience with (Medshield), we certainly do feel that we have any real medical aid cover at all. As based on our experience.

Is this how (Medshield) does business with all their clients?

They are gladly taking the monthly installments but ducking and diving behind encrypted and evasive reasoning as why, they will not do their part. When the customer really needs their medical aid to be there for them?

We are now investigating what will be the best way to push this forward to get answers. Any advice that you can give us will be great appreciated.

We are sharing our experience to everyone; with the hopes they do not have to go through the trauma and stress that we had to face.