Medshield dont want to pay my claim, since Sept 2018, finding reasons not to pay

Hi, this is indeed positive news. Thank you.

Hi Victoria, Firstly i am very confused when you mention in your reply about Bilicor, there is 4 medicines involved not just one.... Secondly for the period July 2018 to October, Medshield received 4 payments, please confirm if that is correct? So you received all your monthly payments. See attached my printout from Dischem, only Pharmacy where i get my medicines from, for the same period July to October 2018. Look at the total columns at the bottom, Total medicines bill R5080.49. Total amount Medshield paid R3547.28 Total member paid myself R1533.21. You talk about suspensions and refill claimed etc, the bottom line is you received for that period all your contributions and still owe me monies for the month i paid myself. How difficult is it.....see printout attached. This claim was approved in principal, i left the country I carried medicines over from August which i did not dispensed, I send you air tickets, passport proof that I left SA and when I came back in October 2018. Then I had to dispensed medicine 2 days before i fly out on the 15 September. Now Medshield has forgotten about me travelling etc. See the printout Mam it tells the whole story. Regards JH Cilliers Printout was emailed on my email reply.....

Thank you, Further on your reply Kindly be advised that we have assessed all claims for bilocor (704373) medication as from July 2018 to December 2018 and we can advise as follow: The scheme processed the following treatment date and paid to the service provider according to scheme rules and benefits available , 25/07/2018 , 03/09/2018 , 15/10/2018 , 29/11/2018 and 28/12/2018 . Mam. July to December is 6 months which you received 6 months monthly contributions from me. You only pay 5 times to the service provider see above the dates, in your hand typing. So what happened to the 1 month you did not pay the service provider???? That's the month I pay them, and you need to refund me. Thats what this whole fighting is all about since Sept 2018. it's a shame...

I think what is fair is fair. If you don't want to pay my claim R1533.21 for the one month, then refund me my monthly contribution for that month which is R8835. Then at least we on equal ground, Medshield don't pay my benefits you promise me I don't pay my contribution for that month....So then refund me my R8835 please. Then all is fair. But you cant except and taken my contribution for that month and not pay me my claim, that's not right.

Its with great disappointment that I read through your reply. Either Medscheme looking for every reason not to pay or I am dealing with people that themselves don't understand the scheme. Once again I am going to embarrasses Medscheme on this public forum. 1. Not sure why u talk about acute medicines, and your reply that my day to day funds were not enough....R108. Mam for the rest of the year you pay that same medicine so where did those funds come from....I honestly dont believe and understand your response. 2. Claim outdated, that same medicine you refer to I send an invoice in October 2018..... 3. Xarelto again rejected day to day funds exhausted........but for Oct and Nov and Dec 2018, you paid it????? You apologies for how badly this claim was treated.....Thank you, but now you come back with weak excuses not to settle the claim and pay me a few rands and sends......R486.48 of a claim of R 1533.21......so you settled only 31,7% of my claim, and think I will be fine. No I am not fine. Please I did contribute 100% monthly not 31,7% for the month. Please pay me the full amount

Mam I paid Medshield from July to Dec 2018, for 6 months, Total R 50010 that's a lot of money, you pay me for 5 months. For some reason beyond my control you only paid me for 5 months. You refused to settle me the 1 month I paid for my own medicines R 1533,21.....that's all I ask. It small change what I claimed and what I paid your Co.......It's a crying shame. From 20+ emails and rejected 6+ times the claim, you now acknowledge you in the wrong and pay me, now you still fighting me and find reasons and what ever to only pay me R486.48. Why so stubborn??? I hope the public that visit this site find the time to read this book we busy writing and come to the conclusion this is not the medical aid to be with.....we members pay your salary Mam, why treating us so horrible and chase us away......so sad. I wonder if your directors/owners/investors in Medshield will be proud or maybe upset to see how their customers are treated. Crying shame.

Medshield, why gone in hiding......you havent refund me, R1533.21......You acknowled certain refunds, pay now what you owe me....

Dear Mam, I notice that you shy away from the truth. How much was approved to repay on my claim....R486.48......How much was the claim? R1553,21....you short paid me by R 1046.73. You further mentioned or create the impression that the refund was done, correctly according to scheme rules and benefits available. Your explanation over the phone makes no sense that some funds daily benefits etc was exhausted....You pay me in full Nov, Dec 2018.....where did those funds come from. I felt once again Medshield is looking for excuses not to pay me and want to alert the broader public that this is the way Medshield dealing with its customers, Ut is a crying shame. mam you collect my full monthly contributions but paid only 31.3% of my claim. After months of fighting where every thing was rejected, you had to show some sort of way to tell the public we going to pay, but I have to point out to them it is only 31.3% because you dont disclose it in your response above. Why not pay the full amount, why you short paid me, monies I am entitled to. I am not happy and want to make it load and clear that your scheme is not trustworthy to do business with. You received all the months contributions, there is one month that you never pay my medicines. i paid it myself and claim it, but you refuse to refund me, now only 31.3%......Please pay my money.....

Good day With reference to your enquiry regarding: 150119Q68DFV. Membership number: ********** 2865. Patient: Jacobus Hendrik. Request for: XARELTO- ********** 01. Kindly be advised that the above medication has been reviewed and rejected correctly as it was claimed too soon. Please note that the medication is not being authorised as chronic medication, this is acute medication hence it was claimed too soon. According to our records medication was claimed on the 03/09/2018 and paid. We trust you find the above in order. Should you require any further assistance please contact the Medshield Medical Scheme Contact Centre on ********** . Yours sincerely Cleopas Tseka MY RESPONSE- PLEASE PAY AS THIS WAS APPROVED BEFORE.......I LEFT THE COUNTRY AND MOTIVATED IT.....MEDSHIELD APPROVE IT. SO PAY THE R400 +R1000 = R1400 Hi Cleopas, I can't believe you responded and with the reason - Rejected Claim to soon....Can you please now pay this amount on top of the R400 + that you agreed you will refund me. Please pay the XARELTO, R1000 plus, why because it was previously approved, look at the history since September 2018. I explain to Medshield then that the reason why I did claim twice in September 2018 and paid for the one dispensary medicine is because I left the country and had not enough medicines to sustain myself. I send Medshield all my proof of airtickets, copies of my passport leaving coming back to SA, invoices for tickets paid by my employer etc. This was all approved that I left the country. The next month I did not claim.....So all of this was approved, please pay me now.....For heaven sake. JH Cilliers

Dear Mam, I just wondering how many avenues Medshield has left over to hide into, not to pay me my money. After how many months, now you send me forms to escalate it for motivation, why not the first time when I am complaining, we going around in circles, this is terrible, and we not one day closer to resolve the matter. Just for the record the monies you agreed to pay, you still haven't paid as well. I will complete your forms, in anticipation you will pay me please, I am left with R1000 that you owe me. The amount of time I have spend trying to resolve this is probably in rand terms more than R10000.....this is crazy......