Claim Avoidance - 3.5months later and counting

Unfortunately, I have to share a negative review relating to the ********* and unprofessional behavior of Kaelo MyHealth Plus as a medical scheme, but it's better that the truth is known for all existing, and potential clients looking to join this scheme for their day-to-day needs.

For the most part, they've been great to deal with up until I actually needed to use them to see a specialist.

I recieved pre-authorization for my Dr's appointment needed beforehand, and when completing my consultation was advised to pay cash, as they do not deal with 'Kaelo Health' as they do not recognize them as a legitimate medical scheme.

I was a bit confused by this, but proceeded to pay cash and then on the same day, I submitted a refund request to be reimbursed for the appointment on the 16th of October 2025!!

After not hearing back from them, I had the matter escalated to the escalations team, to which I received a response confirming that they have recieved all my supoorting documents required and accepted my refund request for payment on the 11th of November 2025, and was told that I will receive my refund within 7-14working days and if I'm not paid back within 30working days, that's when I should contact them.

Another red flag, because only after 30working days is when you must contact them, and not after 14days, in the period stipulated that they 'aim to process the claim within' AND this is now the second time having been given that time frame after the first submission.

Now comes 3rd of December 2025 and still nothing has been done!! so I call to find out what's happening, and the consultant I spoke to, says that she can see my claim, but my banking details are missing?? I did go off pop a bit as my banking details were apart of the supporting documents that needed to be sent to even accept the claim for processing, and after much back and forth on the phone she eventually tells me she's found my banking details and will forward the matter to her team leader to have it sorted out.

Now comes 9th of January 2026 and still nothing has happened!!! I call again, and the consultant says she can see everything is in order on her side, they just haven't updated my banking details and that's why it is still pending!! like are you joking? my banking details haven't changed, as it's the same account no. which they are debiting money from monthly, and they've got my banking confirmation letter uploaded onto the system as confirmed via previous communications, but have been doing everything to avoid refunding my claim.

The same outcome of, "I'll send this to my team leader to follow up" was given.

It's now the 27th of January 2026!!! AND I CALL AGAIN!! with the same excuse that they still have not updated my banking details, and is why my claim is still pending!!

Like what on God's earth could be taking so long to 'update' my banking details??? The honest answer, is NOTHING! - at this point this is considered Claim Avoidance of the highest degree and borderline thievery, as mentioned earlier they are still deducting monthly fees for their subscription but cannot uphold their contractual obligations toward their clientele.

I have spoken to a consultant at the Council of Medical Schemes which Kaelo Health is governed by, to which they agree that what is happening is *********, however, I need to give them a chance to pay me back as 'they've promised' and have said that I am entitled to ask EXACTLY when I will be refunded my amount claimed for, and if I am not happy with their response or outcome of the matter, they will gladly challenge them on my behalf.

So to all existing, and potential clients of Kaelo Health please be aware of what you'll be dealing with, as I do understand that they are a 'budget friendly' option to use, as this is why I am with them myself, but I truly would not recommend them to friends or family, as I would not want anyone else to go through such upheaval when seeking assistance for your health issues, and having this amount of stress, guarantee to make it worse.

Now to Kaelo Health, please do not respond with a generic 'ahhh thank you for bringing this to our attention, and we're sorry to hear about your experience' *** response - GIVE ME A DATE as to when you will be refunding my R1350, WHICH IS WAY PAST DUE!!!