Shocking Service or Lack Of

My baby arrived 7 weeks PREMATURE! With pre-authorisation AND to top it off I upgraded my specific scheme to accommodate any surprises with the help of Medshield via telephone. Not only did they advise me to upgrade they guaranteed that I would be covered no matter what. Not to mention it is one down from their top package. I am on Premium Plus.

Baby was delivered via emergency C-section on the 18th Dec 2017. It is now, 30th May 2018 and I am STILL fighting with them to pay what was a PMB, which by law I might add, they, Medshield, HAVE to pay.

Medshield do not seem to be reading the request correctly. They are declining the modifier code/ tariff code 0019 based on the fact that there was no surgery performed. If I am correct, the code 0019 clearly states:

Surgery on neonates (up to and including 28 days after birth) AND low birth weight infants (less than 2500g) under general anaesthesia (excluding circumcision) per fee for procedure +50% for surgeons and a 50% increase in anaesthetic time units for anaesthesiologists.

This modifier CLEARLY states that it includes and covers infants of LOW BIRTH WEIGHT. My baby was born 7 weeks premature, as stated, he weighed 2kg at birth. All this information is available to the medical aid and has been submitted. And yet they still refuse to pay.

I have reported Medshield to the CMS (Medical Board), who are now investigating the matter further.

I have been with Medshield, previously Oxygen for almost 17years now and this is to date, the worst advice/service ever!

Kind Regards Very unhappy client