AG
AYSHA G

1 reviews | Active since Dec 2010

14 Apr 2015, 09:46

medical emergency not classified as PMB

My son was rushed to the hospital on Sunday 22 March, after falling while playing cricket. He was treated with casts and hospitalised for the evening, he had broken his elbow. Not only was it a medical emergency but the ICD10 codes (S42.40 & W01.30) clearly classify it as PMB, requiring the treatment of this injury to be paid out in full. Medshield has rejected the X-ray claims even though he was hospitalised, notwithstanding this is PMB? They also only paid a quarter of the doctors bill? N1 City hospital advised me that their case managers did send updates on the 23rd and 24th March to MSO updating the authorisation as PMB. The hospital staff also said that they would send out another email to MSO on 27 March. On top of this I sent an email to Medshield on 27 March asking to rectify this situation as well as to look into the unhelpful attitude of the call centre agent at MSO by the name of Zale. I got a query number 270315Q834DS and never heard from them again! Is this customer service? Do you incorrectly classify cases leading you to pay incorrectly? Do you not revert back to your clients timeously? Ppl are not aware of their legal rights pertaining to PMBs & are often duped.

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Replies (1)
Medshield
Medshield's reply14 Apr 2015, 10:06
Official
Hello aysha786,

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