not paying legit claims

On the 22 October 2019 my mother visited Dr. Manga (cardiologist). She needed to see him because her cancer doctor wasn’t happy with her heart readings and my mother is already a longtime sufferer of hyperlipidemia.

On 11 October, prior to her appointment with the cardiologist, I called Medshield, as my mom was worried that the the appointment wouldn’t be covered. I explained that the trouble is with my mom’s heart and cannot be left till January the following year. The consultant said to me not to worry, he will send me a PMB form, which the doctor needs to fill out and her treatment will be covered.

The doctor did the necessary and faxed the forms through, which apparently was never received by Medshield.

The doctor did it again in January this year, and Medhsiled has now loaded it.

From last October last year, to now, the accounts last at Dr. Manga, keeps calling my mom asking for R3735.20 which is the amount for that consultation. The medical aid never paid it.

We pay an amount of R10000 per month for my parents medical aid, and they can’t even go and see specialists in peace? Seriously, I have no words.

Not only is this a PMB condition which should have been funded, but we are paying a premium for my parent's health cover, they should get sufficient funding for specialist and doctors.

I Want this amount paid as a matter of priority as my 76 year old, ill mother is being harassed for funds she does not have.

I sent their complaints department this very same communication nearly a week ago and still not a word from them, while daily my mom is being called.

If this is not sorted promptly, I will be lodging a formal complaint via CMS.