Paying for cover, but having to fight for care while recovering from surgery

I am absolutely disgusted and deeply disappointed by Momentum Health's treatment of me as a loyal, paying client.

After approximately 12 years as a member, I recently - for the first time since being a client - required emergency hospital-based surgery for a serious problem that required maxillofacial specialist surgery and a hospital in-theatre procedure. Momentum covered the hospital account and some of the anaesthetist's costs, but REFUSE to cover the specialist surgeon's account, stating that I must pay it from my own savings because they classify the procedure under their dental benefits.

I formally appealed this decision, setting out the circumstances and asking for the claim to be properly reconsidered. Momentum has not even responded to my appeal!

This is appalling service!!! I pay thousands of rands every month for medical cover precisely so that I have financial protection when I need significant or emergency medical care. Yet when I actually needed urgent surgery, I was left fighting my medical scheme over whether the specialist who performed that surgery would be paid, WHILE TRYING TO RECOVER FROM THE SURGERY!

What makes this even more unacceptable is the complete lack of communication after I formally challenged the decision. I should not have to repeatedly chase a medical scheme for a response while recovering from a medical procedure.

The stress and uncer*****y created by this situation are completely unnecessary and are undermining the very health and wellbeing that I am paying Momentum to help protect.

After 12 years of loyalty, I expected far better from Momentum Health. Refusing to pay a specialist surgical account and then failing even to respond to a formal appeal is an appalling way to treat a paying client.

I am extremely disappointed and have completely lost confidence in the way Momentum Health is ignoring this matter.