COMPLAINT ABOUT THE SERVICES - SIZWE HOSMED

As mandated by the Medical Schemes Act, the treatment of glaucoma falls under the category of Prescribed Minimum Benefits (PMB), necessitating coverage by all medical schemes. Despite this legal obligation, I have faced considerable difficulties in receiving payment for the services rendered by my Eye Specialist, for the treatment of my glaucoma. My Eye Specialist has consistently encountered obstacles in obtaining payment from Sizwe Hosmed, leaving me in a precarious financial situation. In light of this ongoing challenges, ny Eye Specialist has requested that I settle the outstanding amounts for the treatment upfront and seek reimbur*****t from Sizwe Hosmed afterward. However, I am unable to afford the upfront costs, and the prospect of waiting for months to receive reimbur*****t from the medical aid is distressing, especially considering my age and financial circumstances.

Furthermore, despite previous attempts to claim payments from Sizwe Hosmed for services I have already paid for out of pocket, I have yet to receive any reimbur*****t.

As a 68-year-old individual, I am already grappling with the burden of meeting my monthly medical contributions. The additional financial strain imposed by having to cover substantial expenses for a medical condition that falls within the PMB coverage is simply untenable.

It is crucial to recognize that the treatment I am receiving for glaucoma is not optional; it is a critical aspect of maintaining my vision and, consequently, my ability to continue working, as I am the primary breadwinner in my household.

I respectfully request your assistance in resolving this matter, as it not only jeopardizes my access to essential medical care but also violates the legal framework established by the Medical Schemes Act. I trust that your intervention will help facilitate a prompt and equitable resolution to this pressing issue. I am now taking it further to the Council for Medical Schemes.