Claim not settled since 2023 I've been sent Pillar to post for documents and mail trails which I've been sending yet they telling me it's a stale claim but my email trails shows I've been folling up on the claim since weeks after the payment supposed to b

Overdue Claim Payment for claim : AHMED KATHRADA PRIVATE HOSPITAL (PTY) LTD Practice : ***

I have over 100 references which I doubt you even have track of, Please check my profile for a few of these.

I am writing to express my extreme frustration and disappointment regarding the delayed payment of my medical claim. Despite submitting all necessary documentation and following up with your team since August 7, 2023, my claim remains unpaid.

The hospital has not received payment and I have been unable to obtain a clear explanation for the delay. I have consistently paid my medical aid premiums on time and expect prompt service.

1. I confirmed coverage with your team before undergoing the procedure. (Your recorded calls can confirm this)

2. My doctor provided a motivational letter as requested. (to undergo emergency laparoscopic procedure)

3. The hospital resubmitted claims as requested.

I've been advised by your agents to take the following steps, which have yielded no progress:

1. The hospital resubmitted claims, but payment hasn't been made.

2. I was asked to resubmit the motivational letter, but the doctor refuses to redo a letter from 2023, as it was already provided.

Furthermore, I've been told that documents are missing due to an administrative change at Bonita’s. I find it unacceptable that I'm being penalized for your company's oversight.

Every time I call for updates, I'm passed around and given conflicting information, with the latest claim being that it's a "stale claim." This doesn't make sense, given that I've been actively following up on this issue since receiving initial feedback that the claim was unpaid.

I urge you to take immediate action to resolve this matter and provide a clear explanation for the delay.

However, I am now being told that my claim is considered "stale." This contradicts the initial authorization and escalated support I was promised.

I have attached relevant email trails and request immediate assistance in resolving this matter.

If you're unable to resolve my claim issue, I request that you advise on the next steps to escalate this matter to your internal review team or the relevant ombudsman for further investigation and resolution.

Specifically, I would like to know:

1. If there's an internal appeals process I can follow.

2. The contact information for the ombudsman or external dispute resolution body that can assist with my claim.

I appreciate your prompt guidance on this matter.