Ongoing Claims Rejections, Poor Administration and Unpaid Specialist Refund – Kaelo/Dis-Chem Medical Aid

To whom it may concern,

My family and I have been members of the Dis-Chem medical aid administered by Kaelo for approximately three years, and we have consistently paid our contributions on time. Unfortunately, we are extremely frustrated with the ongoing administrative issues and lack of resolution regarding our claims.

In 2021, I went for blood tests through a network doctor. Lancet initially informed us that the claims were rejected due to an incorrect practice number. This was later corrected, and Lancet resubmitted the claims. However, despite this correction, the claims were still not processed correctly.

I have spoken to numerous agents at Kaelo over the past two years, and each time I was told that the issue was Lancet’s fault. However, Lancet has confirmed that they resubmitted the claims after correcting the practice number. If the claims were properly submitted, then the failure to process them appears to be an administrative issue on Kaelo’s side.

Lancet has even escalated the matter to the point of sending attorney letters, which is unacceptable given that we are paid-up members and the services were rendered through a network doctor.

More recently, we had to pay a specialist out of pocket. We submitted the claim for the specialist benefit months ago, but Kaelo has still not reimbursed us. We were informed that the delay is due to the unresolved issue from 2021, which is entirely unfair and unrelated to the recent claim.

This situation has caused us unnecessary stress and financial strain. We expect:

1. Immediate investigation and resolution of the outstanding 2021 blood test claims. 2. Urgent payment of the approved specialist benefit refund. 3. Clear written confirmation of how this matter will be resolved and by when.

We have fulfilled our responsibility by paying our medical aid contributions on time. It is unacceptable that after two years of follow-ups, phone calls, and escalations, this matter remains unresolved.

If this issue is not sorted out urgently, we will have no choice but to reconsider our membership and escalate the matter further.

We request immediate assistance and a formal response.

Kind regards Mahomed Sumadh Ebrahim Sahib KH***8 6743