BAD EXPERIENCE - THERE IS A ROOM FOR IMPROVEMENT

I am at a point of even thinking of changing SAMWUMED. Often times they reject the claims made by my daughter's dermatologist despite attaching the referral letter and i have to settle the bills out of my pocket. The saddest past of it is that when i submit the claims for refund, they were never processed until i am told the period for refund has lapsed.

Since the start of their new procedure regarding specialists referral authorization number this year, I am sitting with unsettled bills that the medical aid rejected even if the referral letters were submitted, because the General Practitioners I consulted, are not aware of this process. I have been on calls being the middle-man between the GPs and the Medical Aid trying to find clarity from the medical aid what exactly they want and go back to the GPs and explain what they need to do based on how this new process work. And unfortunately i am the one that is left with a pile of bills to settle. Was it not the responsibility of SAMWUMED to have notified the medical practitioners of their new changes coming to referral procedures?

Turnaround time to respond to queries is mentioned 3 days when you send an email, but believe me, if you don't do follow-up after 3 days they will take forever to get back to you. The recent one was made with this reference 230824QGWXPH, i had to call the call center when i noticed the delay in their response.

Please SAMWUMED do better by your clients, we pay premiums every month in order to receive better service without hustle.