We are back with the same company and a similar complaint. Medshield did not pay for the main member's PMB pathology claim out of PMB funds - our acute funds are depleted. The reason they supply is that the doctor never submitted the ICD10 codes. We spoke to the accounts department: they did supply the ICD10 codes. Medshield is adamant that the pathologists KNOW that they cannot read the ICD10 codes from their claims. The pathologist says it was submitted electronically. Medshield says they will look into it. The very next email says: we cannot pay for things if there are no ICD10 codes - it is a repeat of the first answer.
How on earth should we resolve issues like these if we cannot speak to people who can help us?
This happened about two weeks after our previous complaint. I have decided to come to Hello Peter every single time I do not get a response from Medshield within 48 hours. Because that is the only way it seems in which we can resolve problems.
I do not want to be unreasonable. But if we are told that this is a benefit, and we pay our contributions then surely we have a right to that benefit? We go out of our way to supply ICD10 codes wherever it is necessary.
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