Medshield does not care about their customers!

We joined Medshield Medical Scheme in August this year. On 19 November 2021 my 2-year-old son was referred to an ENT due to an ear infection. The ENT confirmed that he needs Grommets and we immediately app**** for pre-authorization as the procedure was to take place on 26, November 2021.

Throughout the entire week leading up to the procedure, I called them at least 4 times a day (spending over R500 in airtime) to get some sort of feedback as to why the authorization was taking so long. They informed me that due to the fact that we had only been on the scheme for 3 months they had to investigate, which was fine with me, we had nothing to hide.

Throughout this whole process, I have been extremely stressed and anxious because we had already gone for Covid tests (paid out of our own pockets) The day before the procedure, I really started getting nervous as we still had not heard from anyone and we had to be at the hospital the following morning at 06:30.

When I called them they said they were waiting on a PMA from the referring GP. I called my GP and they informed me that they had not received anything from the medical aid. I then asked the medical aid to resend the PMA and CC me into the email, and they finally received it.

Eventually, the GP sent back the PMA at around 13:00 the day before the procedure, and I immediately called the medical aid to ensure that the matter was escalated. By the end of the day, there was still no update. So on the morning of the procedure, we went to the hospital and were told that we need to wait until the medical aid's call center opens at 08:30 before they can admit my son.

Please keep In mind that my 2-year-old son was not allowed to eat or drink anything since the night before. Once they opened, we called them and they informed me that they were still investigating and that they found evidence of a pre-existing condition. This "pre-existing condition" was an ear infection that my son had a year ago when he was still on Discovery.

I was informed by both his GP and Paediatrician that ear infections are normal in children his age as they pick up all sorts of germs at the crèche, and I specifically asked them if he needs grommets and they said, no! Am I supposed to disclose every common cold he had on their application form as well?

Anyway, the authorization was denied, and we left the hospital at around 11:00. My son has always been on medical aid and has never had a gap in his cover. If I was informed last year that he needed grommets, I would have jumped on the opportunity, and not left him to suffer for a whole year!

I have tried complaining to a supervisor or caseworker at Medshield, but the consultants say they will transfer me, and they keep me on hold until my airtime runs out, or I give up on my own. I have also submitted a complaint via email that has yet to be addressed.

I am highly disgusted in their service and the lack of communication, They are by far the worst medical aid I have ever had to deal with, and will tell anyone that wants to listen about the terrible service they provide their clients.