SHORT PAYING PMB CLAIMS

MEDSHIELD HAS EVOLVED FROM A GENEROUS SCHEME TO ONE THAT HAS BECOME A NIGHTMARE TO DEAL WITH LEAVING PATIENTS TO FOOT OUT BILLS THAT SUPPOSED TO BE COVERED BY LAW SUCH AS PMB DIAGNOSTICS.

ON THE 25/11/2019 MY GRAND MOTHER HAD PATHOLOGY AND RADIOLOGY TEST DONE THE CLAIMS WERE SUBMITTED AND SENT BACK UNPAID. AFTER NUMEROUS INTERVENTIONS CLAIMS WERE REPROCESSED AND A PORTION WAS PAID HOWEVER I DIS NOT REST THERE CAUSE THE TEST THAT WERE DONE ALL FELL WITHIN MY GRANDMOTHERS PMB MANAGED CARE PROTOCOL.

201219QT6HT9 THE ABOVE QUERY WAS CLOSED WITH A RESPONSE STATING THAT THE DOCTOR SHOULD BE CONTACTED TO SUPPLY ICD 10 CODES TO RESUMMIT AND HAVE THE CLAIM PAID OUT. K25.9 AND I25 AND I50 ARE BOTH INDICATED ON THE STATEMENT THAT I HAVE SO WHY ARE THE CLAIMS STILL BEING REJECTED. THE PATIENT IS REGISTERED FOR THE CONDITION PAY THE ****EN BILL.

Secondly radiology query reference.

160120QV3PZ8 & 270120QVML3J THE ABOVE ACCOUNT AS ALSO SHORT PAID THE LIMBS XRAYED WAS PAID FOR RHEUMATOID ARTHRITIS. ONLY ONE OF THE FOUR WHCH I STILL DONT GET. BUT A CHEST XRAY WAS ALSO DONE AND REJECTED DUE TO FUNDS DEPLETED WHEN I ENQUIRED ABOUT CHRONIC FUNDING I WAS TOLD THAT CHEST XRAYS ONLY GET COVERED FOR ASTMA J45.9. I then informed the service provider who than submitted an ammended claim. is was rejected on the same reason i then CALLED THE SERVCE PROVIDER WHO CALLED THE SCHEME AND THEY ALSO SAID THE SAME THING AGAIN THE PATIENT IS REGISTERED THE FOR ASTHMA WHY WAS IS THE CHEST XRAY NOT BEING COVERED.

LASTLY THE CHANGE TO MEDISCOR FROM MEDSHEME WAS THE BIGGEST ****ED DECISION EVER MADE

PLEASE CONTACT ME DIRECTLY TO SHORT OUT THIS ****.

I await a response from rehana rampashad