LA Health worst medical aid

I am writing to formally express my frustration and seek urgent assistance regarding the ongoing issues with our medical aid coverage.

In January 2024, I transferred from my medical aid to my husband’s plan, submitting all required documentation in a timely manner. We are on the same plan, as instructed by our employer due to our marital status. However, despite these efforts, we are still facing significant challenges with our coverage.

In March 2024, I underwent an emergency operation, believing that everything was in order. Now, my husband is facing an unexpected medical bill of R29,000. As we approach November 2024 (9 months later), our medical cover remains unresolved, despite the fact that LA Health receives approximately R10,000 monthly for our coverage. We find ourselves paying cash for doctor visits due to this outstanding amount.

Moreover, I underwent another surgery in September 2024, and the anesthetist has yet to be paid because of this R29,000 debt, the origin of which is still unclear to us. We have repeatedly raised our concerns, but our complaints seem to go unanswered.

We have been advised by the medical aid to contact all doctors and service providers for revised invoices and submit them to the medical aid ourselves. This seems unreasonable, as it is the responsibility of the medical aid to handle these matters, not me as that would be a daunting task.

This situation has caused immense stress for our family, especially during times when we urgently needed medical care. For instance, just last night, our son was unwell, and we hesitated to take him to the emergency room due to the fear of incurring substantial costs without a guarantee of a hospital admission. As a result, we had to wait until the next morning to seek medical attention for our minor child, once again paying out of pocket.

Given the urgency of our situation, I kindly request your immediate assistance in resolving these issues. We cannot continue under these circumstances and are considering switching to a different medical aid provider as soon as possible.

Thank you for your attention to this matter. I look forward to your prompt response.

Sincerely

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