1 reviews | Active since Aug 2013
Not a competitive medical aid
I had an emergency with a blocked bladder a few weeks ago and at around 1:30 am arrived at casualties Mediterranean Clinic for assistance as I am currently pregnant.
I went to medi clinic seeing that this is the network hospital for medshield. When it came to claiming from medshield they only paid for the hospital (R715) and refused to pay the dr himself who was on duty at that time. I sent them an email and they claimed he is not a network Dr. I don't understand how the Dr are not on their network yet he works at medshield's preferred network hospital. This is really pathetic as you cannot choose a Dr to assist you when you have an emergency and need to go to casualties. I have sent mails and they seem very little interested to solve the issue. A real no-care attitude.
When I also accepted to take out the Medshield medical scheme their representatives misinformed me about information especially about benefits on my scheme (as I was honest enough to tell them I am planning on getting pregnant) I was assured that as long as I choose a network option there would be no co payments. So when the time came for my sonar only to realize they have NO gynae listed on my medical scheme and there would be co payment regardless. I then suggested that I upgrade my medical scheme to the better option as this was not the info I received before agreeing to go with medshield and they refused and said that can only be done end of the year. Yet I have seen it be granted to some members on reviews before. I don't understand this as I, the client never received the correct information from the beginning. They hardly pay for anything. If they covered 50% of total costs that would be alot. Really disappointed ad frustrated with this company.
You cannot resolve an issue quickly and effectively as you send emails asking questions and the turnaround time for feedback is up to 5 working days. Then they don't answer all the questions you asked in the first place and you have to re send an email and wait another 5 days to get feedback leaving you with unresolved queries for too long.
I wouldn't recommend this medical scheme at all. They just want to take your money and after that they don't seem to care about you further as long as they have their money.
Medshield Medical Scheme has acknowledged your complaint and is currently investigating.
Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days.
Yours sincerely,
Medshield
Medshield Medical Scheme has acknowledged your complaint and is currently investigating.
Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days.
Yours sincerely,
Medshield
With reference to your enquiry regarding: 170719QJHSPZ Please be advised we have received account dated 10/06/2019 from Nelspruit Private Hospital, practice number *** and Holt And Partners, practice number *** and processed as follow. Nelspruit Private Hospital, practice number *** , amount charged was R 715.00 and it has been paid in full from member day to day benefits .Holt And Partners, practice number ***, amount charged was R1,255.00, and amount paid is R 299.83 . Please note that the doctor charged the private rate on code 0190 ( consultation ) hence we paid R 299.00 out of R 920.00. Furthermore tariff code 0146 ( For an unscheduled emergency consult ) , amount charged was R 335.00 and it has been rejected as is not part of Fixed fee agreement.
It should be noted that causality consultation should be funded from out of area GP consultation where member is given 2 visits per family per annum and once is depleted it will pay from available GP consultation at 100% of the scheme rate, scheme rules and protocols will app****, for example 40% co-payment will be app**** for using non-network doctor. As per our record, please note that out of network GP consultation has been used up , hence ,the account short paid. Please note that Medshield only have GP network , for specialist doctors you may consult with any doctor of your choice , however, the account will be processed and paid up to 100% of scheme rate .
With regarding the option change , please note that as per Medshield scheme rules option change is only allowed once per annum and towards end of the year where the date will be announced . Lastly ,may you please provide us with more details of the broker who assisted by the time you joined the scheme for further investigation .
We trust you find the above in order.
Yours sincerely,
Medshield
With reference to your enquiry regarding: 170719QJHSPZ Please be advised we have received account dated 10/06/2019 from Nelspruit Private Hospital, practice number *** and Holt And Partners, practice number *** and processed as follow. Nelspruit Private Hospital, practice number *** , amount charged was R 715.00 and it has been paid in full from member day to day benefits .Holt And Partners, practice number ***, amount charged was R1,255.00, and amount paid is R 299.83 . Please note that the doctor charged the private rate on code 0190 ( consultation ) hence we paid R 299.00 out of R 920.00. Furthermore tariff code 0146 ( For an unscheduled emergency consult ) , amount charged was R 335.00 and it has been rejected as is not part of Fixed fee agreement.
It should be noted that causality consultation should be funded from out of area GP consultation where member is given 2 visits per family per annum and once is depleted it will pay from available GP consultation at 100% of the scheme rate, scheme rules and protocols will app****, for example 40% co-payment will be app**** for using non-network doctor. As per our record, please note that out of network GP consultation has been used up , hence ,the account short paid. Please note that Medshield only have GP network , for specialist doctors you may consult with any doctor of your choice , however, the account will be processed and paid up to 100% of scheme rate .
With regarding the option change , please note that as per Medshield scheme rules option change is only allowed once per annum and towards end of the year where the date will be announced . Lastly ,may you please provide us with more details of the broker who assisted by the time you joined the scheme for further investigation .
We trust you find the above in order.
Yours sincerely,
Medshield