Unresolved Declined Codes

Dear Medshield Medical Aid Management

I am writing to formally express my disappointment with the handling of my mother’s admission at Fourways Hospital 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, Fourways Hospital has now demanded R10,285 for two codes not approved by the medical aid.

Throughout this process, I have had to make multiple calls to Medshield, only to be given messages to relay back to the hospital instead of receiving direct assistance.

On 16 February, after persistent effort, I finally spoke with Hlengiwe from the pre-authorization department, who advised that a letter from DBC was required to confirm the treatment.

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

It is unacceptable that my 79-year-old mother was expected to manage these stressful queries herself.

I have had to intervene, spending significant time during working hours to resolve this matter.

The lack of proper guidance and support from Medshield has added unnecessary stress and frustration to an already difficult situation. We pay substantial amounts for medical coverage, yet the service levels and accountability demonstrated in this case have been extremely disappointing.

I request that Medshield urgently review this matter, provide clear communication, and ensure that the unjustified claim is withdrawn. I also expect Medshield to take accountability for the poor service and unnecessary distress caused.