Medshield Not Paying Claims

In June 2018, I was admitted to hospital, with authorization from Medshield, for a lumbar puncture procedure after experiencing strange eye movement. The neurologist performed several blood and MRI tests. During the authorization request, I inquired about the possible payment of a MRI procedure as the neurologist informed me that this might have to be done while admitted. The Medshield agent informed me that we only had one MRI per family and that this had been used already. Further to this, she assured me that these procedures will be covered by the medical aid, should the doctor diagnose a PMB condition.

The MRI was done in hospital and the neurologist wrote a motivational letter with the PMB diagnosis. I have ever since been writing emails, communicating with the call center without any success.

Some of these communications are shown below:

I refer to my initial submission on 13 September 2018 of the Pretoria MR Trust outstanding invoices, treatment dates 12, 29 June 2018 - query number 130918Q0DRVT. On 12 October 2018 I requested feedback on this query.

I again submitted the motivation from Dr *** on 17 October 2018, query number 171018Q22SYS.

Medshield informed me on 22 October 2018 that the query has not been resolved yet.

To date I have had no further feedback on this query - kindly resolve and inform me of the outcome.

All that you get from their email system:" Medshield is at present working on resolving your query - 171018Q22SYS."

We will periodically keep you informed of progress made and will contact you once we have reached a resolution. They also send you their service level agreement to which they do not adhere: " Expected query resolution time for emails: 5 working days from date of receipt, excluding weekends and public holidays." The amount of R12 808.95 for the MRI as well as some in-hospital blood tests have been outstanding since June 2018. I have since cancelled my membership with Medshield, i was a member since 2004.