SM
Saphokazi M

1 reviews | Active since Aug 2018

05 Sept 2024, 08:48

Hospital Authorisation for a c-section

If I had the option of not giving a star, I would!

I migrated back to Medshield after being on another medical aid for 5 months due to work. When I rejoined I disclosed all my medical history again and even informed them that I was pregnant and my pregnancy was covered by Bonitas.

In spite all of this I was informed that I would have a 3 months waiting period, which I felt was unfair considering that for close to a decade I'd been with Medshield, wasn't covered by them for 5 months, but went back again - but still had uninterrupted medical aid. I had a back and forth with their consultants who informed me that all my conditions would only be covered after the 3 months waiting period and that this is what their under writers had determined.

Now that my baby is due, they have switched up and declined my hospitalisation, saying that I haven't been with the scheme long enough. This is not what had been communicate to me by their consultants - who told me that my pregnancy and pre-existing conditions would be covered.

For months after rejoining I had to pay out of pocket for my chronic asthma and allergy medication and doctors visits, which I'd been told would be covered and I found out weren't. Even now they still have not approved my script for said medication and have been paying out of the daily benefits for it.

For Medshield to decline a c-section after a myomectomy is a clear disregard of their clients well being. To make matters worse via email I get a letter stating that my authorisation is pending, whilst on the app I get a letter stating that it has been declined.

Careless and disgusting conduct!

0
Replies (2)
Medshield
Medshield's reply05 Sept 2024, 12:44
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 urgently.
    Yours sincerely,
Medshield Medical Scheme 
SM
Saphokazi M's update06 Sept 2024, 14:45
Reviewer Update
So Medshield's authorisation department which declined my authorisation stating that its due to me not being with scheme long enough (less than a year) and had completely disregarded the fact that I belonged to another medical aid and that their own under written policy that;

1. That the 3 month general waiting period with PMB coverage was app****
2. All pre-existing disclosed conditions are covered
3. Membership is active with no waiting periods or exclusions

So according to the consultant that declined my authorisation all of the above is immaterial, should my baby come early whilst they drag their feet at approving my c-section and hospital care afterwards, I will have to cover all costs out of pocket.

I am at my wits end and this is causing unnecessary stress!