PM
Patricia M

1 reviews | Active since May 2019

04 Jun 2020, 17:25

PMB Quotation for delivery

Dear Medshiled must say I am utterly disappointed for your lack of urgency and empathy to your members. After close to 5 years being under this medical aid with people speaking ill of it but I chose to continue being a member as I felt I had never been disappointed yet. My claims always get paid in time. But this time the only thing I wanted was just for the scheme to check my quotation for delivery day. Medshield does not have a list of designated specialists so I ended up using a gynae that charges above scheme rates requesting R4000 co-payment. According to CMS pregnancy forms part of PMB conditions with my understanding as well of being in medical aid administration field I understand, co-payment cannot be app**** for involuntary use of DSP. Also PMB can be paid up to 300% scheme rate. After numerous calls I made to the scheme, and emails I sent with some of your agents telling me O8.0 is not a valid ICD code,I have a pending query opened since 20/05/2020 regarding this matter nobody seems to know how to attend this matter. Can you please resolve this query as I need to provide feedback to provider. I feel it is unfair that I have to pay such a large co-payment and still pay my premiums. Worse I had to switch from Gynaecologist claiming within scheme rates as they were using a Non-DSP hospital, now I got a doctor that uses your DSP but yet I am still required to pop up so much money on top still. So I tried to play by the rules to avoid a 25% hospital co-payment to still pay out of my pocket.

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Replies (1)
Medshield
Medshield's reply05 Jun 2020, 05:24
Official
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 urgently.
 
 Yours sincerely,
Medshield