1 reviews | Active since Jul 2016
PLEASE EXPLAIN PROPERLY
MY GRAND MOTHER HAS CHRONIC CONDITION HOWEVER IT IS ONLY JUNE AND HER MEDICATION CHRONIC BENEFIT HAS BEEN DEPLETED OPTIVE PLUS FOR RHUMATOID AS NOT BEING PAID ANYMORE. HER NEXIFLUX FOR PEPTIC ULCER PMB CONDITION ALSO BEING REJECTED . FURTHER MORE CO PAYMENTS ARE BEING APP**** WHY ERROR CODES LIKE PAYMENT REDUCED AND PAID AT SCHEME RATE OR PAID ACCORDING TO NUMBER APPROVED. I DO NOT UNDER STAND THIS SCHEME RULES PLEASE GET A KNOWLEDGEABLE CONSULTANT TO CALL BACK AS THIS IS A COMPLICATED MATTER. I DO NOT WANT A HAP HAZARD ANSWER OR RESPONSE.
Good day,
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
Best regards,
Good day,
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
Best regards,
Good day,
Medshield Medical Scheme has acknowledged your complaint and would like to thank you for bringing your concerns to our attention. Upon the investigation we can advise as follow:
With regards chronic medication benefits, the family limit per PA is R 11,420.00 and R 5,710.00 per dependent. Please note chronic medication benefits for dependent 00 Veronica Rebecca has been depleted only PMB level of care condition may be funded over and above the benefits.
It should be noted that Optive plus eye drops & Nexi-flux 20mg medication has been approved for chronic however are not PMB level of care hence the claim has been rejected as chronic medication has been depleted.
Peptic ulcer condition is not covered on the MediPlus option and is also not PMB level of care. It should be noted that Mediplus option utilizes the restrictive formulary and out of formulary medication will attract the 40% out of formulary co-payment, if medication are dispensed from non DPS pharmacy only scheme rate will be paid and member will be liable for the shortfall.
I will attach the updated list for the restrictive formulary, send it to your personal email address. Please note that is subject to changes however member may also go to Medscheme portal to see the updated medication
We trust you find the above in order.
Yours sincerely,
Medshield
Best regards,
Good day,
Medshield Medical Scheme has acknowledged your complaint and would like to thank you for bringing your concerns to our attention. Upon the investigation we can advise as follow:
With regards chronic medication benefits, the family limit per PA is R 11,420.00 and R 5,710.00 per dependent. Please note chronic medication benefits for dependent 00 Veronica Rebecca has been depleted only PMB level of care condition may be funded over and above the benefits.
It should be noted that Optive plus eye drops & Nexi-flux 20mg medication has been approved for chronic however are not PMB level of care hence the claim has been rejected as chronic medication has been depleted.
Peptic ulcer condition is not covered on the MediPlus option and is also not PMB level of care. It should be noted that Mediplus option utilizes the restrictive formulary and out of formulary medication will attract the 40% out of formulary co-payment, if medication are dispensed from non DPS pharmacy only scheme rate will be paid and member will be liable for the shortfall.
I will attach the updated list for the restrictive formulary, send it to your personal email address. Please note that is subject to changes however member may also go to Medscheme portal to see the updated medication
We trust you find the above in order.
Yours sincerely,
Medshield
Best regards,