Medishield is no good

I am extremely disappointed with Medshield. My wife required an operation, but when the procedure was submitted for authorisation, Medshield refused to fund the less invasive option, which would have required only one night in hospital.

Instead, they were prepared to fund a much more invasive open operation that could have resulted in around 10 days in ICU and a significantly longer hospital stay, with greater risks and potentially more than R50,000 in additional costs.

I had to pay for the safer, less invasive operation from my own pocket so my wife could receive the treatment she needed.

My question is: who makes these medical decisions, what medical expertise do they have, and what logic is used to reject a cheaper procedure while accepting a far more invasive and potentially much more expensive option?

It makes no sense medically or financially.

Medshield is very quick to deduct monthly premiums, but when you actually need them, getting appropriate treatment approved becomes a completely different story. Based on this experience, I cannot recommend Medshield to anyone.