Medshield refusing to commit benefits to member

I write this as a last desperate effort as I am refused to speak to anyone who has the authority to whom I could direct my concern. I now hope that this will find a way through the blockage. Early last year I was diagnosed with a left hip Labrum tear with cartilage fracture. An arthroscopy was done, a review after 3 months a hip replacement was the only resolve as per the orthopedic surgeon, as I still had severe pain. After a few months I decided to have the replacement done. The operation is scheduled for 30 June at Zuid Afrikaans hospital. I contacted Medshield to get the authorization I waited 3 days when on inquiry Medshield then they stated they were working on it. With further inquiry I was told that joint replacements were excluded from my option. I found this very weird as I could not find any revision correspondence from the fund, I also looked at the list of exclusions on their webpage but couldn’t find anything. What surprised me most was the fact that they still covered internal prosthesis on my plan. I asked the surgeon to submit the authorization application again, we waited another 3 days. They asked for reports from the surgeon. Two day later authorization was declined, stated that it is an exclusion.

The withholding of authorization for my urgent hip replacement surgery stating joint replacement surgery has been excluded from my plan option with them since January of this year. Nowhere has this exclusion been published and I was not notified in any way, shape or form of this exclusion. I contacted the CMS but it will take 6 months to resolve. I could borrow money and pay for the procedure, but what happens if there are complications which Medshield won’t cover, and I do not have the means to pay for. So I was told I can wait to upgrade in December to a higher plan where they MUST pay anyway but waiting that long will put severe strain and further decay on my joint that would risk the success of the procedure or even further costs to the fund. So I urge you to please cover my procedure.