Shoddy Customer Care

Never has claiming and having issues resolved speedily been as bad. After having an ICD10 code (one of many) for a fracture (??) rejected by this medical aid - and having to have doctors resubmit their claims, consderation for a PMB was requested. Clearly this scheme does not wish to entertain this? Time frame given at the outset for a decision for a PMB was 7 to 14 days, then an end date of the 23rd May was given, according to their SLA, (****** the customer ??) and today a 16 business day period for this review was stated on an advice from this scheme (****** the customer twice??). That is after I requested this be given some urgency based on theri delay in responding to their initial rejection, and resubmission of the claim. No time frame was given on "Rejected - under administrator review "either. This amounts to a rather large grey hole where this scheme does as they wish without the due considertaion they claim, and without speeding up resolution to ensure all accounts are settled and without undue delay. On top of this - codes rejected are not covered by Gap Cover. So if this scheme has member interests at heart as they say, they would ensure issues such as these are addressed post haste and with definite timeframes and clear outcomes. As a member for more than a decade I certainly cannot recommend this scheme anymore in any way.