1 reviews | Active since Nov 2016
Medshield Medical Aid, no service delivery
I have been a member of Medshield for 9 years now. I have never previously had a problem, but this year has been very frustrating and disappointing. Making me think to change my medical aid.
My partner had a procedure done at a day clinic on the 8th of may, there were 3 claims. All the necessary documents were uploaded by the relevant parties to claim from Medshield. 2 were paid out so far.
For the third Medshield claim, firstly, Medshield said that the docs were not submitted, so I submitted in June. I called a week later, and I was told its in processing, it takes 5-7 day, I called again the following week, firstly the agent could not find the submission, when he finally found it, he said he would escalate it. I left it a week and called again, and again it could be found and finally when it was found, I was told that it would be escalated.
Today I called again and again the agent could not find my claim initially, after about 10 minutes he finds it and I am told that it has not yet been sent for processing. This is after a month of been submitted.
Why is it that we have to call in to remind them how to do their jobs, if I had submitted at a certain date and received a claim number, why was nothing done about it at the time?
So disappointed
I don't understand the nitty gritty when it comes to medical aid claims. (I have medical aid and gap cover for this reason.) But this has gone on too far. From May to August.
I have had further comms from the hospital where the procedure was done. It has all been negative and they have tried to contact Medsheild my medical aid themselves on my behalf to be paid.
This is a letter that was sent from the hospital where the procedure was done.
"GOOD DAY
Please see attached
1. AUTH LETTER FROM DENIS
2. PAPER CLAIM FROM THE HOSPITAL
DENIS AND MEDSHIELD DID NOT LOAD THE AUTHORIZATION PROPERLY!
THIS IS AN INTERNAL ERROR. THIS CLAIM WAS SUBMITTED MONTHS AGO.
CORRECT THIS MATTER-INTERNALLY.
IT IS ABSOLUTELY UNACCEPTABLE THAT WE ARE EXPECTED TO CONTACT DENIS, THE AUTH DEPARTMENT AT MEDSHIELD AND THE HOSPITAL CLAIMS DEPARTMENT AND EACH DEPARTMENT IS REFERRING US TO THE OTHER.
IF MEDSHIELD DECIDES TO OUTSOURCE DENTAL ADMINISTRATION, THEN LOAD THE AUTHORIZATIONS PROPERLY!
I don't blame the person who typed the letter (in all caps). Asking for the matter to be resolved, the service provider deserves to be paid.
I did call today the 15th August 2023. And I was told the query has been escalated only yesterday 14th August from complaint being laid on the 3rd of August. I asked for timeliness, Unfortunately call center can't help because the query is handled by "back office" who works from home. Therefore there are no timelines.
It has now been in excess of 90 days. I think I have full recourse to go to a higher authority and get answers, as I am now being held liable for the bill.
I don't understand the nitty gritty when it comes to medical aid claims. (I have medical aid and gap cover for this reason.) But this has gone on too far. From May to August.
I have had further comms from the hospital where the procedure was done. It has all been negative and they have tried to contact Medsheild my medical aid themselves on my behalf to be paid.
This is a letter that was sent from the hospital where the procedure was done.
"GOOD DAY
Please see attached
1. AUTH LETTER FROM DENIS
2. PAPER CLAIM FROM THE HOSPITAL
DENIS AND MEDSHIELD DID NOT LOAD THE AUTHORIZATION PROPERLY!
THIS IS AN INTERNAL ERROR. THIS CLAIM WAS SUBMITTED MONTHS AGO.
CORRECT THIS MATTER-INTERNALLY.
IT IS ABSOLUTELY UNACCEPTABLE THAT WE ARE EXPECTED TO CONTACT DENIS, THE AUTH DEPARTMENT AT MEDSHIELD AND THE HOSPITAL CLAIMS DEPARTMENT AND EACH DEPARTMENT IS REFERRING US TO THE OTHER.
IF MEDSHIELD DECIDES TO OUTSOURCE DENTAL ADMINISTRATION, THEN LOAD THE AUTHORIZATIONS PROPERLY!
I don't blame the person who typed the letter (in all caps). Asking for the matter to be resolved, the service provider deserves to be paid.
I did call today the 15th August 2023. And I was told the query has been escalated only yesterday 14th August from complaint being laid on the 3rd of August. I asked for timeliness, Unfortunately call center can't help because the query is handled by "back office" who works from home. Therefore there are no timelines.
It has now been in excess of 90 days. I think I have full recourse to go to a higher authority and get answers, as I am now being held liable for the bill.