Requesting Payment for Procedure not Done

Dear Fourways Hospital Management,

I am writing to formally lodge a complaint regarding the handling of my mother’s admission from 06 May to 09 May 2025

While the hospital stay was covered by her medical aid and the specialists’ claims were settled by Gap Cover

I have now received a demand from the hospital for R10,285 relating to two codes not approved by the medical aid

I have engaged extensively with your staff, including Takalani Mathube, Rose Magongwa (Case Manager General), and Sibahle Xhali, yet no one has provided clear or accurate information

Instead, I have been repeatedly told that the amount must be paid, despite the fact that the medical aid advised otherwise

On 16 February, after multiple calls, I finally spoke with Hlengiwe from the pre-authorization department, who confirmed that a letter from DBC was required to validate the treatment.

I obtained this letter and submitted it to the Medical Aid Authorization Department, but the codes were still declined. See attached

Throughout this process, my 79-year-old mother was expected to manage these stressful queries herself, which is unacceptable. I have had to intervene, spending significant time during working hours to resolve this matter.

The lack of proper assistance and communication from both the hospital and Medshield Medical Aid has been deeply disappointing.

We pay substantial amounts for medical coverage, and the service levels we have experienced are shocking.

I request that this matter be urgently reviewed, that the hospital withdraw the unjustified claim, and that both Fourways Hospital and Medshield Medical Aid take accountability for the poor service and unnecessary distress caused.