NONE PAYMENT OF CASUALITY PAYMENT ON A PMB CASE

This medical scheme is lacking empathy I am so disappointed and furious for promoting this medical fund to my peers and my family and friends. We are in a pandemic things are not operating as business as usual surely like Bonitas the organisation I am working for if they make exception during this time in this period of Covid-19 Medshield should follow suite on what Bonitas is doing.

On 15 December 2020 evening my son got burned 2-3 degree burns as per hospital assessment due to the pandemic Netcare Sunninghill hospital had limitation on bed which was explained upfront and rules on admission process in these times I would have to go for Covid-19 test both me and my son as only 1 parent allowed in the wards.

With this screaming child and skin hanging from his right arm due to the burn hospital indicated they would have first spray some gel and dress him accordingly for the heat to be extracted from his arms for he next 2 days before going to theatre.

Medshield is not considering the pandemic and the circumstance around this and the trauma I had endured seeing my son in that state as the authorisation is PMB because the hospitals are also following their safety protocols it makes sense why they insist on covid tests results and why on the two days I had to take the hospital to casualty so they can observe the wound before operating/heading to theatre.

I have casualty claims which are over 2k for he 2days before theatre there is an auth which demonstrates there were consultations I am told medical aid is not paying because of scheme rules which can be reviewed as an exception under these circumstances this is a bad experience which I will share to people I meet about this medical as it is unfair.

Below is a poor response in them no wanting to pay these claims.

"Dear Member.

Kindly be advised the accounts received prior to admission date of the 17/12/2020 has been rejected as day to day limit was exhausted. The scheme states only on admission from casualty if a authorisation is obtained can those accounts be linked to the authorisation. The covid19 test for dependant Lehlotlonolo for treatment date 16/12/2020, Drs Du Buisson was paid for by Medshield from a Risk pool on the 04/01/2021. The covid19 test received for yourself for the 16/12/2020 was rejected as limit exhausted as Medshield paid a covid19 test from a Risk benefit on the 01/06/2020. The second covid test will only be paid if the test is positive when the test results are received from the pathogist."

I am in this medical thinking it will cover me in my time of need by they only here to put me into debt on something they could avoid in making my experience comfortable.

If I had my way I could move to another medical fund never in the 4years think I would get such treatment from this scheme.