Highly frustrated and disappointed

I was rushed to hospital on June 07th and treated for Sepsis, it was a horrible experience & was discharged June 15th. I submitted my claim forms ( claim form, hospital invoice & blood results ) on June 20th. Received my reference ***.

I didn't see any movement on the app so I called in the next day where I was told no claim was received, after providing my reference....the consultant said it was received and now attached to my profile.

As days passed, I still saw no movement on the app and began calling daily for an update.....I was always told....its with the assessor.

On Friday, June 28th....I called again, the consultant then put me on hold and called the assessor....after returning to our call she said that "due to it being critical, it's not with the assessor any longer and has been handed to the chief medical officer who contacted the hospital and doctor.

Today, on the 8th day....I received a call from the assessor, she enquired about where sepsis had come from....this information was not given to me....furthermore, it could have been contracted from any infection. The assessor proceeds to say that she requires for the admitting Doctor to complete a form ( mind you, this is a specialist ). I did express my disappointment as on Friday, I was told that the chief medical officer already made contact. Checking my app, I see it's now updated. That means, the claim only was only worked on today

My disappointment comes due to me understanding that this is NOT a medical aid, however when we take these covers out, it's for our protection or to cover medical costs. I was just diagnosed with Mayasthenia gravis and gout. My medical aid plan doesn't cover these conditions and medication for this is ****** expensive. I've been paying cash and obviously depended on these funds to purchase my medication. Now, 8 working days later I'm told "we don't contact the doctor, I will send you forms that you need to send to Docror. The issue with this is....

Why is the claim only being worked on 8 days later? Further to that, it states on the form that I ( the patient ) is responsible for payment to complete the documents. As mentioned, these are specialists....forms will NOT be completed immediately, at times, we can barely get an appointment.....so here's delay number 1

The other delay is that once documents are completed, I ( the patient ) will need to make payment to the specialist in order for him to release the completed form.....

Where does FNB expect us to get funds for this? In my case, I haven't worked in months.....how/when would I pay the doctor to release the document....and this will cause delay number 2

I've taken up this plan in January this year, this is my 2nd claim. My 1st one was paid without any issues for my abscess on my stomach. This get cleaned every 3 days and sealed with a vacuum bag, it's not infected and healing well.

I'm highly disappointed that we as members/patients have to deal with this when we are recovering. I haven't walked since my discharge and in a severe gout flare, so you can only imagine the pain....now I have to be following up on this and stressing about payment for specialists etc. This is so unfair and unnecessary as sepsis could have come from any infection, furthermore FNB advertises these plans and make it so enticing for us, claims with ease....but it's seeming to be far from that