PMB Claims and excuses

<p>Claims and proof of payments were submitted to the fund on 17 June 2016 by member ********** to be processed as PMB claims and to be refunded to the member. After 2 weeks, no response from the fund.</p> <p> </p> <p>Only after phoning the fund, the claims were registered and references given. 1 claim was handled smoothly, but the second claim was short paid again and paid to the supplier even though it was indicated to the fund that they must reimburse the member, before the payment was processed. The fund however still processed with the payment.</p> <p> </p> <p>Sending emails and phoning numerous times, we were instructed to submit the already submitted statements and proof of payments AGAIN. On 25 August 2016 the fund processed another amount, short paid again, for the supplier and once again not the member. Having made phone calls again, the payment to the supplier was changed to the member, but the payment that was made first has still not been reversed and paid to the member.</p> <p> </p> <p>With numerous emails and phone calls AGAIN regarding this claim and being promised that they will return to us, they still did not phone us back. Only being told yesterday that the member must sort their wrong payment to the supplier and that the remainder of the short payment will not be paid due to the supplier charging higher tarriffs than what is covered by the medical aid. Yet the first claim was also higher and the very same processes were followed. I would really like to understand the logic in that.</p> <p> </p> <p>I lodged a formal complaint with the council of medical schemes as Moto Health Care simply does not want to communicate or provide a proper service to their paying members.</p>