Bad Client Service and no assistance in claim payments

To whom it may concern

I am sending this email on behalf of my mother Mrs EWA Kruyshaar.

ID *** Cell *** Email – ***

My mom went for Right knee replacement on 04.11.2024.

Since 28 December 2024 I have been struggling to get claims sorted for Dr JA Ellis *** due to codes not updated – calling the case manager of Midvaal Hospital requesting the codes to be updated. Getting an email from her where confirmation was received from Sizwe that the codes have been updated. PLEASE SEE ATTACHMENT. Goeie More

Voorspoedige Nuwe jaar vir jou en gesin, Sizwe het vanoggend weer n confirmasie gestuur, altwee codes is nou op.

Ever since I have been calling – being sent from pillar to post – codes still not updated, speaking to Lebo in pre-auth confirming it has been. Then been told claim is under review.

Then the claim for anaesthetist is rejected for no auth – calling again – auth Nr NEO***A is on the claim – when I call – it is been rejected as his codes were not pre-authed.

Transferred to pre-auth – no pre-auth for PR 10 is required.

Every week I call and every week I get the same answer – the claim is under review.

Queeneth in call centre requested I email her for feedback – NONE RECEIVED Palesa in call centre said she will ensure the claim is paid on the run for 27.01.2025 and will call me back – NO FEEDBACK Molly in call centre – there is a backlog and will ask to Palesa to give me a call – no ref Nr given as I demanded feedback today and call was dropped. Spoke to Grace, Lesego, Maria, Mthembu, Yvonne – all giving the same feedback – claim under review.

REF NR’S RECEIVED N***, N***, N***, N***, N***, N***, N*** –today no ref Nr received.

I ALSO WORK FOR A MEDICAL AID – I UNDERSTAND THE STRESS YOU HAVE WITH A BACKLOG BUT PLEASE KEEP MEMBERS UPDATED.

I NEED A MANAGER OR THE CEO TO GIVE ME A CALL BACK – IF YOU PROMISE A MEMBER FEEDBACK – YOU GIVE A CALL BACK WITH THE INFORMATION YOU HAVE.

I HAVE HEARD FROM THE 3RD OF JANUARY THAT THE CLAIM IS UNDER REVIEW – WHY NOT BE HONEST AND SAY THERE IS A BACKLOGG?????

WHY IS A CALL BEING DROPPED WHEN MEMBERS GET FRUSTRATED?????

MY MOTHER IS A PENSIONER – HER MONTHLY INSTALLMENT R9788 – PAID BY EMPLOYER AND CHILDREN?

IS THIS HOW YOU TREAT YOUR MEMBERS – NO CUSTOMER SERVICE AT ALL???

MY CELL NR – ***