refusing to pay bills

My mum is a recovering breast cancer patient. She is no longer on treatment, but has to go to see her oncologist twice a year to do blood tests and a check up to make sure that the cancer has not returned.

On 26 May 2021 my mom went to see her oncologist, Dr Demetriou. Medhsield are refusing to pay her consultation fee of R650.

The Dr's accounts lady called Medshield today and was answered by Shane (ref no: 030621QLMRB9). She explained to him that my mother does not have a morphology code as she isn't on a treatment plan. She goes in twice year and that amount has got to be paid from their basket of care. Shane outright refuses. He is adamant that Medshield will not pay.

So we pay around R6000 per month for just two people - and as a recovering cancer patient they are refusing to pay her check ups? We all know that cancer is a PMB. These check ups are part of her ongoing care. How can they refuse to pay this? There are enough funds, their annual benefits and saving cannot be used up. My mom has seen virtually NO doctor this year, so what do we have a medical aid for? If this is not sorted I will indeed be asking CMS to have a look into this.