Below par customer care

My sister spoke highly of the then-Hosmed in 2020, After battling with high medical contributions from my previous medical aid , I decided to give them a try because my sister and husband had been with them for more than 15 years and they never complained. I must say all was well. I was so impressed with their offerings. No scheme is perfect; there will always be challenges. After consultation with a gynecologist in 2021 she referred me to the urologist. I didn't mind when the specialist told me that they were not taking my medical aid and I needed to pay, as I knew I would be reimbursed. It took time, but eventually I was refunded. Again, the issue of private rates vs. medical aid rates came into play. My chronic, as prescribed by the urologist was approved at that time, which was a plus for me. Then the merger of Sizwe and Hosmed happened, and the headache started. the very same chronic that was approved, I was told I needed to resubmit it for authorization, and I obliged, though I asked myself if there was a data takeover, why resubmit? Then, in December, I received feedback that my bladder condition was not covered by my plan. Now make it makes sense that the first two months' supply before the merger was processed successfully, post-merger the situation changed. I had to make a submission on December 21 of the detailed sequence of events. Feedback received in January 2022 was in the affirmative, but the conditions attached to it were strict for that year. After 6 months, it went back for review, and another script was submitted. Now things have changed. I needed R500 per month for my chronic medications, which unfortunately I am still paying out of my pocket till today, and prices have increased. The reimbur*****ts received during Hosmed time were better than the ones received post-merger with Sizwe which didn't make sense. The customer service is so terrible and not aligned to their slogan, "choice for quality care." I have on several occasions told the contact center how this medical aid is going to increase my grey hair.

My son needed orthodontic treatment which started on Dec 21 and till July 23, another setback, then you were told all sorts of excuses why the costs of assessments, imaging, etc. could not be paid by the dental risk company. I had to make a submission only then approval was granted with conditions. You ask yourself why must one always lay complaint before you can be considered? Again I paid almost every month out of my pocket because the treating Dr doesn't take medical aid for the program. I hoped to be reimbursed guess what? I didn't get a fraction of the total costs incurred but because as a parent you want your child to have an aligned teeth structure you will pay. Comparing the total costs incurred the what I received back, honestly, you will cry when you are told about scheme rules.

I was admitted on September 22 for a major procedure; yes, they covered it; however, the shortfall was crazy. I had in excess of R60k that was not covered by the medical aid in a tax year. Looking at the receipts and proof of payments, I still get chest pains. The treating specialists had to be paid the shortfall, including the hospital itself, and the issue of medical aid rates vs. private rates came to play For the first time in October this year, I was told about co-payments for GPs, and you are referred to the scheme rules on the Value option. By the way, this medical aid had two contribution increases in one year, but the service continues to deteriorate. I am sitting here evaluating my options how i wish to return Hosmed service, as Sizwe-Hosmed is one disastrous scheme. It pains me that I had to shop for medical aid. Their premium will increase but the service offering decreases.