Subject: Formal Complaint About Unsatisfactory Service and Unresolved Claims - Urgent Intervention Needed. Query No's [MI***/ MI***/MI***/MI***Q36W61/[OPTIVEST]***/ MI***Q2Y9HT [Last 5 days constant

Subject: Formal Complaint About Unsatisfactory Service and Unresolved Claims - Urgent Intervention Needed. Query No's [MI***/ MI***/MI***/MI***Q36W61/[OPTIVEST]***/ MI***Q2Y9HT [Last 5 days constantly busy sending follow-up emails with no feedback] / 120424Q4PKF/120424Q4PKF8..... and so its an ongoing struggle....

I am now reaching out to Hello Peter seeking help, escalate a serious issue regarding the handling of claims on my Medshield account. We enrolled in Medshield in June 2023, started using the fund for the first time in February 2024. Despite being subject to a waiting period for my husband due to his pre-existing conditions of diabetes and myself, epilepsy, which we fully understood and accepted, we have been met with numerous challenges and disappointments in utilizing our coverage.

The trouble began during our annual consultation at new healthcare providers in our area, whom we selected based on their status as Medshield service providers. Regrettably, most of our bills have either not been settled or nit paid in full, not sure if it has been a case of incorrect information provided to us by their representatives when we joined the scheme.

A particularly distressing incident involved a referral to an Orthopedic Surgeon, who indicated the necessity of an MRI at a hospital within the Medshield network. Following the requisite authorization process, we were informed of a co-payment, which I promptly settled in order to proceed with the assessment. Subsequently, after nearly two weeks after the services I received already becauseof the informationthat it was approved with the co-payment involved, I was notified via email that approval for the MRI had been denied.

The MRI results revealed an urgent need for a surgical operation. I diligently submitted all related documentation through the Medshield App for authorization, only to be notified of its outright denial. Efforts to obtain clarification on the reason for this decision have been met with frustration and unanswered inquiries since March, leaving me in a precarious medical situation without clarity or support.

The lack of transparency, delayed responses, and inconsistent handling of claims go against the essence of the coverage and service quality we expect and deserve as members of Medshield. Given the critical nature of my condition and the immediate need for medical intervention, I implore them to intervene without further delay, provide a thorough explanation for the denial of services, and expedite the approval process for the required operation, no success up to date.. Only automatic email replies that they acknowledge my emails with a case no after every mail.

I have exhausted all possible avenues seeking resolution within various departments to no avail, hence this formal complaint as a final recourse for urgent action. I trust that Medshield will acknowledge the gravity of this situation and take swift and decisive steps to rectify the concerns outlined above.

Hence all my queries, emails, social media requests, phone calls etc, concerning for my upcoming operation scheduled for April 16th, as discussed, Optivest, the broker service affiliated with Medshield, has been in contact with me twice, assuring me of their assistance in navigating the authorization process. Consequently, I promptly furnished all necessary documents and communications to them, eagerly anticipating clarification on the reasons behind the declined authentication. NO FEEDBAC AFTER 3 FOLLOW-UP EMAILS

With my surgical procedure approaching rapidly, it is paramount that I understand the status of the funding approval. The pre-operative protocol mandates ceasing all medications seven days prior to the surgery date, a step I am prepared to undertake as soon as I receive confirmation on the financial aspect from the fund.

Despite our substantial contributions to the funds to support coverage for my spouse and myself, alongside the additional GAP Cover and Broker services, uncer*****ies persist regarding the utilization of these benefits. Since initiating coverage in June 2023, we have diligently paid into the system. However, disconcertingly, we have encountered multiple instances where we were forced to cover costs totaling nearly R20,000.00 out of pocket due to co-payments and declined treatments.

Given the significant financial commitment we have made and the imminent nature of my medical procedure, clarity on the funding status is critical. I am eager to be informed of any updates or additional information that may shed light on the situation and provide reassurance regarding the coverage for my upcoming operation and hope that Hello Peter will bring some outcome on any feedback/fillowup on all my requests.

Hence all my efforts to get proper information concerning towards my upcoming operation scheduled for April 16th, as discussed, Optivest, the broker service affiliated with Medshield, has been in contact with me twice, [because of me commenting on ads on social media] assuring me of their assistance in navigating the authorization process. Consequently, I promptly furnished all necessary documents and communications to them, eagerly anticipating clarification on the reasons behind the declined authentication.

Despite our substantial contributions to the funds to support coverage for my spouse and myself, alongside the additional GAP Cover and Broker services, uncer*****ies persist regarding the utilization of these benefits. Since initiating coverage in June 2023, we have diligently paid into the system. However, disconcertingly, we have encountered multiple instances where we were forced to cover costs totaling nearly R20,000.00 out of pocket due to co-payments and declined treatments.

Given the significant financial commitment we have made and the imminent nature of my medical procedure, clarity on the funding status is critical. I am eager to be informed of any updates or additional information that may shed light on the situation and provide reassurance regarding the coverage for my upcoming operation.

Your prompt attention to this matter is greatly appreciated, as it is crucial for me to have a clear understanding of the financial implications before proceeding with the scheduled surgery.

Thank you for your time and assistance. I look forward to your response and resolution on this pressing issue.