Unpaid claim of R5000

Mediphila option is the worst.

My kids (two) were admitted to the hospital for the same illness a week after each other. Their paediatrician ran bloods tests for (both kids) using the same code. The challenge is that according to the Medshield call centre agent we spoke to; the paediatrician selected an umbrella code for the tests instead of a specific code. The interesting thing is that the umbrella code also includes the specific code that Medshield insists should have been used.

Medshield got back to us saying that they could only pay (the claim of R5000) if the pathologists changed the code to reflect the specific code they want. We then contacted the pathologist to seek the necessary amendments, they too refused saying that they are not allowed to change a code which the Dr (paediatrician) had already signed for. We informed Medshield that the pathologist is not allowed to change the code. In response, Medshield rejected the claim of R5000.