Hosmed a bad choice of schemes

<p>I have been a member of hosmed for 8 years. I never realised that the day I needed them they would turn out to be such a waste of money. So many providers refuse to submit to hosmed, due to their huge delay in payment, so I paid most of these bills myself and being so busy never got around to submitting.</p> <p> </p> <p>This year I had a rough financial time, the kind of time when you think "thank heavens for medical aid" as you really need them to do what you Pay them for right? and that's be there when you can't afford those medical bills - a medical aid is supposed to give you peace of mind.</p> <p> </p> <p>Well, I hurt my back (I am a fire fighter so need to be in top form) and after seeing a physio I submitted my caim.... three months later I had forgotten all about the claim, and had to go see a specialist as my back was not better, as well as a physio.... so off I go.... R800 for specialist and R1240 for three physio sessions and I submit.</p> <p>This time however, I need the cash back in my account as soon as possible. Two weeks go by, I phone hosmed to enquire as to whether they received my account as I have heard nothing - and they tell me that it was rejected as there was no refferring doctors name. I tell them that it was in the email body, "no! that wont do, we dont read the email, we just forward the attached bill to the payment department" they say. I enquire about the previous account which I submitted and they tell me the same. I ask why did they not let me know so that I could have rectified it. They tell me that they send an email to let you know whether your claim is accepted or not. When I tell them I received no word, they tell me that from now on I will, it was just because my email was not on their system. I find that odd, as my email has always been the same since I joined but I indulge them and give them the address again.</p> <p>In the meantime they tell me I do not have to worry, they will print out the email with the referring doctors details on it and give it to the claims department by hand right away.</p> <p> </p> <p>I thank them and hang up. Then I realse the doctors name was in fact on both accounts anyway. It was just the practice number which was needed and that was in the email. But I let it go as I think it is now solved.</p> <p> </p> <p>A week goes by, I phone again, after my cell phone clocks over 2 minutes holding on their menu options I finally get an operator. I enquire about my claim. Go through the whole (lOng) process of security questions (too long), enquire about my claim, another long wait of giving the date, doctors name, etc etc (I only have the 2 claims, surely it is on the system?) but ok. He finds it, finally, and my phone time runs out. I buy another R55, get a new operator, have to do it all again, she says she is going to check for me and leaves the ohine..... I wait.... and wait..... try calling into the phone hping she is nearby and can hear.... my phone time runs out. I buy R29 more, phone again.... new operator.... now I have to explain it all again.... the first thing I say is... I cannot talk long my phone time is not inexhaustible..... I ask why my claim has not been paid - her reply.... no doctors practice number. Believe it or not I am frustrated but not yet angry, although Iam concerned as I literally need the cash nOw. I am so low on funds at this point that I am about to run out of electricity and have just spent the last of my food money on phone time. </p> <p>This time when I ask why no one informed me my claim was rejected agaIn, they change the story - they are an incoming call centre, they do not contact you to let you know if your claim has been approved or not. By this point I have learned the name of a very helpful call agent, Nikita Frances, the only one who seems interested. (I have not outlined all the calls I made, it was more than this) The agent Im on with tells me they only do payment runs on Fridays and that it will be paid on Friday. In another phone call I am informed that I should have been paid as I have never claimed and my full benefit is available. This is another promise of payment on another coming Friday.</p> <p> </p> <p>Friday comes and goes.</p> <p> </p> <p>Over and over again.</p> <p> </p> <p>My kids have been eating soya mince and bread. And even that is running low. I cannot believe I was stupid enough to use our food budget to pay the physio, trusting that it would be repaid. </p> <p> </p> <p>I do not know how many phone calls I have made, except that in the last two weeks, I have given up. I just cant afford the constant phone time, it's racking up to hundreds, I cant afford to end up spending what I am trying to claim back. </p> <p> </p> <p>Two months later, many promises and no repayment, and I am angry! I also have to pay my sister back for the specialist (which she paid) so payday is another cruncher.</p> <p> </p> <p>Thank you Hosmed for your wonderful (sarcastic) service. We trust you to be there for us in times which are difficult and often emotional and as a medical scheme we believe that you will perform the duties which we, regular hard working citizens, pay you for - from our hard earned money, we pay you to ensure that we and our families have peace of mind during rather important events I might add.</p> <p> </p> <p>On the whole I am thoroughly disappointed. I cannot believe that this is allowed but mostly I am disheartened that a mEdical scheme could care so little and really leave one hanging in such a way.</p> <p> </p> <p>I can only guess what would have happened had my sister not stepped up so many times before to assist when my step son needed to have his wisdom teeth out. He was not on my medical aid and quite frankly I am relieved that my partner never got around to filling out thos forms to put them on my medical aid.</p> <p> </p> <p>How much more money would I have wasted and how much worse would it have been.</p> <p> </p> <p>Do not join Hosmed!!!!!!! I regret ever telling my colleagues to join. I will be sending the opposite message from now on.</p> <p> </p> <p>I am changing schemes when it comes time in November. I will not look back.</p>