Medshield
Reviews and Complaints

Medshield has the work administrative staff in the world. They have failed to reply on claims that has been submitted over 3 months ago after the member contacting them on 4 separate occasions. They will contact you immediately if your debit order failed and suspend your benefits in 3 days - but when you submit your rightful claims via their outlined processes, they ignore their customers' right to healthcare.

These are the people claiming to have your health on their hearts.

This is not the first time this statement popped up on a Pharmacy's screen. The first time I paid the dues and contacted Medshield.

I was helped and the matter was resolved(so I thought). Same scenario, same route to have it rectified, same result..."We added Dr. ... as your prescribed doctor"

Here I am today, same old same old.

SUGGESTION:

Confirm rectification by means of an e-mail, SMS, and keep record of such rectification on client's information file.

My cost of returning home without my medicine, travelling, time, etc should be reimbursed by Medshield as I did what was required of me to comply by Medshield's rules and regulations.

Member
AS de Bruyn
Nr [protected]
ID [protected]

Dear Medshield

I will try my best to complain in English. I am the caretaker of AS de Bruyn. She was in Eugene Hospital where she was treated with respect. She is a alzheimers pasient. On the 18 September she was well and was transfer to Medstep. The reason was to help her with physio to make her walk. With her alzheimers they let me in any time. Then I started to complain they must clean her. Every time when I was at her bedside she was smelly. I also comlain about other stuff. They give her something to sleep. On Friday the 20th September her grand daughter and I had a meeting with dr Deon du Toit, Carlien social workers, physio and a sister. They promise Lizl that they will stop sedate her. Saturday when I visit she was sedated again. I phone Lizl. Lizl phone them. They said it is to calm her down. She was so far gone and whit that they handcuff her. The 23 September I went to visit at 10h30 she was a sleep. I rang the bell for the reason she was lying with a dirty nappy. The suster came and ask what I want. I explain. Her answer was we clean this 2 pasient a few minutes ago. I walk out a male nurse with the name Justine ask me if I am okay. I respond no. Ask him went did they changed oumas nappy. He said just after breakfast. I believed him because of the smell I walk in. That afternoon when I want to visit the security gaurd stop me and told me I can not go in. On Wednesday the 25 I call a ambulans and arrange with Medstep that I am taking het to Eugene emergency. She was very sick. Emergency took photos she was so burned. Was admitted and at this moment she is laying in Icu.
All I whant to know what must we do to prevent it happenig to othet alzheimer pasient? And Medshield I am sure already pay the bill there.

Lizl [protected]
Antoinette [protected]

Regard
Antoinette

Ns Sorry I am afrikaans and struggle to explain clearly

Settled fee with Service provider total up to a cost of R 767.30. Provider indicated that they treat at Medical Aid Scheme fees. Claim to be settled back to patient from Scheme equals up to R 361.00. Provide breakdown and documentation to support calculation of claim within Seven (7) days to avoid listing with Medical Instructions. Claim [protected] to be settle in full if Service Providers charge at Medical rates. Please supply rate scale to support evidence.

I have just had a look at the app an seen that my day to day benefits has been used which is untrue as I have not been to the dr this year. I was involved in an accident jan an y guys refusing to pay the radiology bill for netcare kuils river. What is happening my medical reference is claims status - 55200915359 [mi633132326]. It seems that the radiology not including an to my knowledge it should be included with my hospital benefit an now netcare sending me letters of demand as well.

We are members at medshield medical aid, option mediplus, member number [protected].

My wife ls pretorius had a spinal operation, performed by dr ja louw, on 14th of november 2017 at the life faerie glen hospital in pretoria.

Prior to the operation there were numerous tests that had to be performed, and pre-authorization was given for the said operation.

We received a very detailed letter before the operation, stating all the before and after care, as well as the notice that we are responsible for submitting the account to our medical aid, and to do regular follow-up calls to make sure it is paid.

In the notice from dr louw, appeared the following quote: according to the act on medical schemes, act 131 of 1998, article 59 (20) stipulates: "it is the scheme's obligation to pay a claim to the member within 30 days from receipt thereof". and I suppose it is also meant to be paid to the person that rendered the service, if so preferred.

The account was received by me on the 22nd of november via e-mail, and on the same day forwarded to medshield, and claim was acknowledged the same day.

From there on we phoned regularly, and first there appeared to be a problem with the authorization codes, and next time another story, and in the meanwhile most of the other accounts - faerie glen hospital, sunningdale hospital (step-down) and just about all the parties involved in supplying service to the operation, was paid about 4 to 5 days after accounts were submitted.

On the 22nd of december 2017 we again spoke to an supervisor, keenan johnson, and I told him that I feel very bad because it is now 30 days after account was submitted, and still unpaid, and I am going to pay the account, because I signed the contract with the dr. he said they are working on the case, and so I was told every 3 or 4 days.

The query number was 221217qjt86l, and is still not resolved. all e-mails sent and calls made concerning this problem is stored and recorded under this number.

On the 23rd of december we received a general note form medshield, stating they have a system problem and some account payments will be delayed. the note was dated 16th of november 2017 - we received it on the 23rd of december?
Dear member

Delay in the processing of some claims

Medshield recently upgraded its claims processing system as part of its commitment to remain on the competing edge of technology. once upgraded, the system will enable automated processing that previously required manual intervention. this will result in quicker claims payment turn-around, therefore ensuring that you continue to enjoy the extraordinary customer service that you have become accustomed to.

Claims were placed on hold on thursday, 16 november 2017, and implementation proceeded as expected. the scheme continued with the processing of claims but due to a technical glitch we encountered some processing difficulties which lead to the incorrect payment of claims. subsequently claims could not be paid and will remain as such until the issues are resolved.

Medshield is cognisant of the impact the current situation will have on some of your claims and we have allocated additional resources to the project to ensure a speedy resolution.

We sincerely apologise for any inconvenience experienced and appreciate your patience while we resolve the situation and finalise the system upgrade.

All queries relating to this communication may be discussed with an agent on [protected] or email to [protected]@medshield.co.za.

Yours sincerely,

Ms angela blackburn
Executive: operations | medshield medical scheme

On or about the 4th of january 2017 I withdrew money form my savings, and paved the account (r23 702.32), after arrangements was made with the dr.'s office to refund me when they receive payment from medshield.

On the 15th (yesterday) I spoke with as "section manager"?, a mr modire, at medshield, and he promised (one again) he would get back to me before 17:00 - which he did not do! (once again). I did advise him that I am going to hellopeter.com today.

All the calls are on tape at medshield, and the given query number would give all information.

I must admit that this is the first time in many years that we have a problem like this, and in general we are quite happy with medshield, but, in a case like this, whenever a problem like this occur, I would like to see e more senior person should be getting involved, and at least contact the member, and explain there problem. the I can forward it to the dr.'s office, so at least they can get first hand information directly, and not from the member.

As member, my subs are deducted every month via debit order, what more can I do? no one is going to re-imburse me for all the time that i/we have spent on the phone trying to solve the problem, nor for the costs of the phone calls, nor for the interest I loose on the savings I used to pay the dr.'s account.

From 19 June till 27 June 2017 I have been phoning Medshield medical aid and Medshield medical scheme to find out if I will be covered for an urgent procedure I need.

I was given 5 different numbers to phone and still do not have an answer.
Everybody was very friendly but I cannot understand how nobody can tell me what is going on after I held on for hours.

Surely there must be some information on the computers.

Medshield cannot help you with answers but they have no problem at all when it comes to taking your contribution every month.

My husband needed urgent medical attention and a procedure to fix his failing heart. When I tried to authorise I was told my husband does not qualify for life threatening conditions he can go next year august. I tried to explain he might not be alive by then as he can't even walk 5 steps, his feet, hand and face already started swelling and he lost feelings in his feet and hands already. He can't even talk without not having breath. I was told by their teamleaders to "deal with it". Mso their administators just refer you back to Medshield. Your not allowed to speak to their general management only to teamleaders. When I said my husband is dying I was told to take him to a public facility. The lady said I should have listened to the consultant who done my application - I explained to her that he said my husband will be help in any life threatening emergency as to which she said :"sorry she appoligse he gave me the wrong information". The consultant represent Medshield as well as the teamleader - who is telling the truth? All I asked was for them to allow my husband his theatre procedure on the 12th in order to fix his heart and safe his life. Clearly saving lives is not a priority at Medshield anymore. Clearly all the talk of they care for their members and their members is important is just talk nothing more. I had to sent so many e-mails this past two days to no avail. Is it so much to ask to grant you one auth for one procedure to save a life? Is that not why we have medical aid? Is my husband's life really to no value to them? I almost never claim any hospital admission unless it's an emergency, I pay my membership fees every month, but when you really need medical care, even if its a PMB(life threatening) then your rejected?

On the 21/108/2015 my husband who is a dependent on my Medical Aid being "Medsheild", was suffering with chest pains. Upon visiting our Doctor, we were told that my husband needs to be admitted in hospital and he needs to undergo various tests regarding his heart. He was then referred to a specialist. Upon the specialist's tests my husband was then admitted to hospital and he was to undergo more tests and an Angiogram. Medsheild closes offices at 4:30pm and are closed on weekends so if we need authorization we must wait for them to be back at work or they give us a whole lot of problems. We joined the Medical Aid in July 2015 and were placed on a late joiner penalty and had to wait three months before using the medical aid. We waited the three months and we can attribute this to Murphy's Law that my husband who never had a heart problem or a problem with his chest, happen to now get severe pains in his chest. My husband was however admitted in hospital but come the next day Medshield continued to give us a problem. I explained to them that this is an emergency but it fell on deaf ears. I was told that they need both medical practitioners' contact details and they will assist. I gave them the contact details and they then liaised with the medical practitioners. It is now Monday the 26/10/2015 and albeit the forms having been signed and forwarded to Medsheild, I was told to wait until the next morning as they will be closing soon. My husband is at home and awaiting the feedback from Medsheild and he could suffer a severe even fatal heart-attack and Medsheild just does not care enough to speed up the process.

I emailed medshield and got documents to register adopted baby. They insist on 3 month waiting period because baby was not registered within 60 days of birth, but we only got her at almost 8 months. Tried sending emails but no proper feedback. Then now they phone me. . . But the agent can't speak english at all and just drops the phone! I am ny now so pissed off it is no longer funny. I expect my child to be covered now or i will find a medical aid that is worh the monthly payments and that actually care about their!

I gave birth in 2007 in GMC cape town my baby was fransfered to Red cross hospital after 7days she had an operation there costed R12 000 medishield did'nt pay it I am paying it via lawyers and I'm listed. I have tried medshield to pay for it for 3years I have decided to cancel my medical aid after 14years of being a member.

I am up in arms with Medshield! For 3 weeks I've been calling them to find out about a payment for a claim that I submitted to them. For 3 weeks they've told me that the claim in in process and that it will be paid out on the Thursday. Thursday came and gone and a promise were made for the next Thursday. I called yesterday with the hope that it might be this Thursday and got told that they will not pay me out and in fact the entire bill will not be paid. Why couldn't they tell me this 3 weeks ago! I just want to cancel my Medshield medical aid and move on and they refuse to cancel my medical aid! They cannot force me as a consumer to stay with them. I feel that their service is very bad from the beginning and that I can't allow Medshield to gamble with my life! If I need to get legal advise on this I will, I just want to leave them and go to someone else!

They take your money but just try and get an authorisation for something. We've recently moved to Medshield and they took us on with no exclusions or waiting periods but aside from that we did inform them of the tumor-like growth in my brain. After seeing the neurosurgeon about 2 weeks ago he said that I should go for another MRI. That's where the trouble started. We've booked with a hospital after which they (the hospital) contacted us to say that it's not authorised by Medshield. We contacted Medshield and they said it takes a week for auth which I thought is a bit long given the seriousness of the case. Gave them a week and phoned again after which they said that they are waiting for a report from our house doctor. Asked if they have the house doctor's details and they said no. So, how can you wait for the report if you haven't even contacted the doctor! Gave them the house doctor details a week ago, guess what, we're still waiting for Dumisile to get back to us with an auth after two weeks. They are quick to take your money but you must follow up with them each and every day if you want something from them.
You'll do good to look somewhere else for a medical scheme.

I needed to switch my husband to the main member as I had changed companies and was required to leave my current medical aid if I was the main member. I did not want to leave Medshield, so we decided to simply switch the main member. BIG MISTAKE!

It took many phone calls and emails to medshield before I got the correct information from Medshield around the process for switching the member and the dependant and when we finally had everything in place I called to confirm that the current benefits would be transferred and not forfeited. I was guaranteed that this was the case as it was simply a member switch and not a whole new application. I phoned today to be told that it is a medical scheme rule that benefits get forfeited when a member switch is done. I now have been told to write a letter to the Medshield management to request they review my case, probably another waste of time. They are quick to offer advice as experts, but don't have the authority to act on issues caused by their advice. R15000 for 2 doctors visits and a handful of medication! And the funny thing is I am still the one paying them!

I decided to join as dependant on my fiance's scheme after she received excellent service from you for the past 8 months. But whats happening now? I only joined medshield this month (20th) and ALREADY having problems. You deducted R1911 instead of R1308. When I send my application through, I asked on 2 occasions to 2 different people what the first an total monthly contribution will be and was told R1308 for the both of us. Today I spoke to Carmen who was very kind and helpfull and was told that it must be a mistake and said she will put a req in for the amount of R603 to be reversed. I really hope to see that amount to be reversed a.s.a.p. Let's hope this was the first and last problem.