EE
Estelle E

1 reviews | Active since Mar 2009

27 Jan 2024, 14:37

Authorizing but refusing to pay!

My husband was admitted to the Mediclinic in Nelspruit's High Care/ICU suffering from kidney failure, cellulitis and septic shock on 7 July 2023.

Authorization was obtained by the hospital. Sizwe Hosmed is refusing to pay R30 818-38 due to the hospital claiming for High Care instead of ICU being authorized.

Im stuck between the hospital and the medical aid and being sent from pillar to post while the hospital is keeping me responsible for the outstanding amount.

The hospital indicated that emails from them to Sizwe Hosmed are being deleted without opening or reading it.

Please, please, please, can the medical aid and hospital communicate with one another to get this issue resolved as I am very frustrated with the whole situation???? Ive sent numerous emails, made numerous (very long) telephone calls and the issue is still unresolved.

Sizwe Hosmed is not struggling to get my premium of R15k per month from me, but I am struggling to get them to pay bills for which Authorization was obtained.

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Replies (2)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply29 Jan 2024, 07:49
Official
Dear Estelle,

Thank you for submitting the query, we sincerely apologise for the inconvenience caused. 
We will be in contact with you to resolve your complaint. 

Sizwe Hosmed team 
EE
Estelle E's update30 Jan 2024, 16:49
Reviewer Update
I am still waiting to be contacted by Sizwe Hosmed.