Medshield refuses to pay PMB

Due to retirement I had to find a more affordable medical aid scheme. I was introduced to Medshield and with that my problems also started. Since trying to join Medshield I had administrative problems. You never get to talk to the decision makers only consultants who allways understand your problems and frustrations, as they are only the consultants they are in no position to take decisions, so, you find yourself in a position of "don't shoot the messenger". In most cases you walk away being on the short end, that was my experience on a few oūcasions. I developed anemia, due to the delay in the authorisation process (almost 4 months) to be referred to a gastroenterologist. I was admitted to hospital for a blood transfusion. When I eventually got to see the gastroenterologist in PE I was then referred to a gastroentorologist in Cape Town as the problem could not be resolved in PE. Appointments were made and a week was set aside for this procedure as I was travelling from Jeffreys Bay. Authorisation was requested to see the gastroentorollogist who performed various tests. Test nr 1 was a out of hospital procedure, for the second set of tests I had to be hospitalised and when authorisation was requested I was then informed that this specific hospital was not covered by my medical aid. When I took out this plan, one of my requirements were that I do not want to be limited to certain hospitals, I was informed that my plan covers all hospitals. This only came to my knowledge when authorisation for hospitalisation was requested. This specific specialist only performed work in that specific hospital, alternative arrangements had to be made on a very short notice to find me another Dr and a hospital covered by the medical aid. I was admitted to that hospital and the new Dr continued with the tests, he could not find the leakage of blood where the 1st Dr had found it and for which I was originally send to Cape Town. By then my blood counts were also very low and i received an iron infusion. The Dr then decided as a last resort to perform a CT scan whilst I am in hospital. When authorisation was obtained, it was declined. The Dr was informed and he stated that the procedure must be treated as a PMB case, and should be covered by the medical aid as I was in hospital and it is of the utmost importance that the scan must be performed. Travelling all the way from Jeffreys Bay, which already had cost implications of its own, being hospitalized, and not feeling well, and you are being informed that your health is at risk, so you do the obvious with the Drs motivation and a 100% hospital coverage and a unlimited PMB benefit, what do you do, you do what is best for your health. The scan also did not deliver a solution to the amnesia problem and the specialist decided to discharge me and to monitor my condition via my GP. When the bill for the CT scan was presented, the med aid refused to settle it due to no funds available for radiation. I contacted the medical aid and informed them that what specialist informed me, it should be treated as a PMB, they then requested reports from the Dr, which was submitted and once again declined. I again contacted the medical aid and was informed by the consultant that the claim was declined as my illness had no name and that a cause of the illness could also not be detected with the CT scan, but I could appeal should the Dr write a motivation for the scan, which the dr did and in which he stated that he is surprised that the claim could not be treated as a PMB and settled by the medical aid. Once again none of this was taken into consideration, only reason provided then by the med aid, no funds available for radiation. The Dr over ride this reason by providing his motivation stating that it must be treated as a PMB case. My question is what happened to my 100% med aid coverage whilst hospitalised as well as my unlimited PMB benefit. I have comp**** by submitting a motivation provided by a highly recommended and very well qualified specialist. How can this be override by a medical consultant and be declined and not be treated as a PMB. With all the excuses from Medshield to have it registered as a PMB it has become clear to me that Medshield has got no concern for a person's health, it is not their primary goal, I find it all as just excuses not to settle the bill, I am so disappointed in Medshield as a medical aid scheme, and I would certainly not recommend it as a medical scheme to join compairing it to my previous medical scheme which I had to resign due to my retirement as it was part of my salary.