Formal Complaint – Outstanding Claims and Lack of Response - Sizwe Hosmed Medical Scheme

To whom it may concern ,

I am writing to lodge a formal complaint on behalf of my 72-year-old mother, regarding numerous outstanding medical accounts related to her hospital admission and surgery in November 2025 at Netcare Alberton.

Since her procedure, she has been inundated with doctors’ accounts amounting to thousands of rands, with one account exceeding R100,000. In addition, letters of demand are now being issued, causing significant stress and financial anxiety for a pensioner. One of the doctors’ rooms has even advised that payment was initially made by Sizwe Medical Fund but was subsequently reversed. This is extremely concerning and requires urgent clarification.

Despite sending daily emails requesting assistance, I have received no response whatsoever. My mother has also not received any communication. Furthermore, when she calls the Sizwe call centre, she is kept on hold for more than 30 minutes at a time, only to receive no meaningful assistance.

I have noticed that Sizwe responds to complaints on HelloPeter; however, these appear to be automated responses. My question is whether Sizwe actually follows up with complainants, as to date neither my mother nor I have received any direct feedback or resolution.

This situation is completely unacceptable. My mother pays nearly R7,000 per month for her medical aid as a pensioner, yet the fund is not settling accounts. Additionally, many doctors and pharmacies no longer accept Sizwe, forcing her to pay cash for consultations and medication out of pocket.

This is placing an unfair and unreasonable financial burden on an elderly member who has faithfully paid her premiums. We require the following urgently:

A full explanation for the unpaid and reversed claims

Immediate settlement of outstanding accounts related to the November 2025 admission

Written confirmation of benefits and coverage going forward

A dedicated contact person to resolve this matter

If this matter is not addressed urgently, we will have no option but to escalate the complaint further to the relevant regulatory bodies and continue reporting the issue publicly.

We trust that Sizwe will treat this complaint with the seriousness it deserves and provide an urgent resolution.

You can contact me on *** as I know if I send anything to you I will get no response.