Shocking

Good day

I don't understand the nitty gritty when it comes to medical aid claims. (I have medical aid and gap cover for this reason.) But this has gone on too far. From May to August.

I have had further comms from the hospital where the procedure was done. It is all negative and they have tried to contact Medsheild my medical aid themselves on my behalf to be paid.

This is a letter that was sent from the hospital where the procedure was done.

"GOOD DAY

Please see attached

1. AUTH LETTER FROM DENIS 2. PAPER CLAIM FROM THE HOSPITAL

DENIS AND MEDSHIELD DID NOT LOAD THE AUTHORIZATION PROPERLY!

THIS IS AN INTERNAL ERROR. THIS CLAIM WAS SUBMITTED MONTHS AGO.

CORRECT THIS MATTER-INTERNALLY.

IT IS ABSOLUTELY UNACCEPTABLE THAT WE ARE EXPECTED TO CONTACT DENIS, THE AUTH DEPARTMENT AT MEDSHIELD AND THE HOSPITAL CLAIMS DEPARTMENT AND EACH DEPARTMENT IS REFERRING US TO THE OTHER.

IF MEDSHIELD DECIDES TO OUTSOURCE DENTAL ADMINISTRATION, THEN LOAD THE AUTHORIZATIONS PROPERLY!

THE CLAIM ATTACHED NEEDS TO BE PROCESSED IMEMDIATELY.

WE ARE TREATING YOUR PATIENT. MR GREGORY. B FINDLAY IS A MEMBER OF YOUR MEDICAL AID.

AND YOUR CONDUCT IN PAYING THE SERVICE PROVIDER'S PROMPTLY WHEN THE ERROR IS INTERNAL IS APPAUALING.

I EXPECT FEEDBACK AND THIS CLAIM TO BE PROCESSED BEFORE THE END OF WORKING HOURS TODAY (03/08/2023)"

I don't blame the person who typed the letter (in all caps). Asking for the matter to be resolved, the service provider deserves to be paid.

I did call today the 15th August 2023. And I was told the query has been escalated only yesterday 14th August from complaint being laid on the 3rd of August. I asked for timeliness, Unfortunately call center can't help because the query is handled by "back office" who works from home. Therefore there are no timeliness.

It has now been in excess of 90 days. I think I have full recourse to go to a higher authority and get answers?