Co
Clairwyn o'reilly
1 reviews | Active since Nov 2023
20 Nov 2024, 06:28
Medical claim approved not paid
I received hospital authorization to cover endoscopy, colonoscopy and fiscal removal, now medshield are not paying the endoscopy of R4768 after authorization was given, very disappointed as no-one can resolve my query going backwards snd forwards between medshield and life st Dominic's hospital, and I don't have the R4768 to pay for this
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Replies (2)
Medshield's replyOfficial
20 Nov 2024, 09:05 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
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
Medshield's reply20 Nov 2024, 09:05
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
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
Co
Clairwyn o'reilly's updateReviewer Update
22 Nov 2024, 14:34Kindly note I have received the Feedback as follows - "Thank you for querying the above-mentioned account, please be advised that the short payment is on the theatre code 97200 and code 97638 gastroscope, procedure code 43235 has been declined on the authorisation.
Kindly be advised that the clinical information was reviewed by Medical advisor and no PMB diagnosis applies related to the gastroscopy therefore funding of gastroscopy is declined.
Below is proof of authorisation, that Medshield is now saying is declined. If Medshield was going to decline it, I would have opted not to have the scope, but it was done because of the initial approval. I want a Senior Manager to contact me as I am now done communicating this matter via e-mail backwards and forward. How can they approve the Gastroscopy, and then decide to decline it?
image.png 57.89 KB
Kindly be advised that the clinical information was reviewed by Medical advisor and no PMB diagnosis applies related to the gastroscopy therefore funding of gastroscopy is declined.
Below is proof of authorisation, that Medshield is now saying is declined. If Medshield was going to decline it, I would have opted not to have the scope, but it was done because of the initial approval. I want a Senior Manager to contact me as I am now done communicating this matter via e-mail backwards and forward. How can they approve the Gastroscopy, and then decide to decline it?
image.png 57.89 KB
Co
Clairwyn o'reilly's update22 Nov 2024, 14:34
Reviewer Update
Kindly note I have received the Feedback as follows - "Thank you for querying the above-mentioned account, please be advised that the short payment is on the theatre code 97200 and code 97638 gastroscope, procedure code 43235 has been declined on the authorisation.
Kindly be advised that the clinical information was reviewed by Medical advisor and no PMB diagnosis applies related to the gastroscopy therefore funding of gastroscopy is declined.
Below is proof of authorisation, that Medshield is now saying is declined. If Medshield was going to decline it, I would have opted not to have the scope, but it was done because of the initial approval. I want a Senior Manager to contact me as I am now done communicating this matter via e-mail backwards and forward. How can they approve the Gastroscopy, and then decide to decline it?
image.png 57.89 KB
Kindly be advised that the clinical information was reviewed by Medical advisor and no PMB diagnosis applies related to the gastroscopy therefore funding of gastroscopy is declined.
Below is proof of authorisation, that Medshield is now saying is declined. If Medshield was going to decline it, I would have opted not to have the scope, but it was done because of the initial approval. I want a Senior Manager to contact me as I am now done communicating this matter via e-mail backwards and forward. How can they approve the Gastroscopy, and then decide to decline it?
image.png 57.89 KB