Unjustified Authorization Decline Due to Erroneous Hospital Coding – ***

On 3 September 2026, Medshield Medical Scheme issued a formal decline for emergency hospital authorization (***) regarding my emergency admission on 1 September 2026. I am the principal member, Miss Nomthandazo Bongiwe Rieta Ndlovu, on the Mediphila option (Member Number: ***).The scheme has declined the authorization under ICD-10 code M43.62 (Torticollis, Cervical Region). This decline is based entirely on incorrect clinical coding submitted by the attending emergency room doctor at Milpark Hospital. I never presented with, nor did I report, standard cervical neck pain or stiffness.I presented to the emergency room following a motor vehicle accident with acute difficulty breathing, chest tightness, upper body swelling, persistent vomiting, severe pain inside my neck/throat, and abnormal bleeding noted after using the bathroom (which I explicitly confirmed to the nursing staff was not due to a menstrual period).The attending physician completely miscoded my multi-system trauma symptoms as a simple, routine case of "torticollis" to the medical aid. I demand that a clinical case manager review this file immediately in the context of an emergency trauma presentation and a motor vehicle accident so this unfair decline can be reversed.