Horrible/Annoying service

Good day

I've had an unpleasant experience of getting calls from my family's medical service providers querying as to why are some of the usual consults etc. are not being paid. I had a call on Modnay the 3rd February2025 from my daughter's dentist telling me that there seems to be an issue with my medical aid, and that their records show that I am on a Hosmed Value option but my Medical Aid is suddenly telling them that I am no longer on that option. And they wanted to know if I had downgraded because currently my daughter is undergoing Orthodontic treatment from December last year (2024), and under Hosmed Value, they had motivated and app**** for Specialized Dentistry funding using Xrays and Moulds amongst other things, which was approved. This amount granted wasn't much, but about R5000 for a year, however it helped. Now this being a new year they had app**** for this Specialized Dentistry, but were told that I no longer have this under my new option and needless to say I was both surprised and annoyed, thinking that there must be a mistake as I didn't authorize any changes to my Options.

I then called Hosmed to clarify this and was told that yes,I no longer am on Hosmed Value but on Gold Ascend option, and under this option there is no Specialized Dentistry funding. I was annoyed that if there has been some fundamental changes and structural adjustment to the Medical aid options, in the absence of a member signing or authorizing such a change or adjustment, it would make sense that such a member would be transferred horizontally and "placed" is an option where he/she would be in similar position regarding benefits OR the next better option upwards, as NOT doing so but instead DOWNGRADING certainly would and indeed HAS negatively affect (ed) the members and their dependents financially, as this has been in my case. This is also the case with a lot of my colleagues within our Durban Municipality, where Hosmed is only one of (about 6) of the Medical Aids that are on the panel of approved schemes. As a Shopsteward, I've had people complaining about their Chronic Medication and treatments that now Hosmed is saying that They must go back to their specialists and request that new tests and approvals must be sought through the medial aid so that they can continue to receive chronic benefits and this would entail going and effectively starting from scratch to undergo tests and motivations only to be placed back in the position that they were in, before these changes came into effect, and personally this I find abhorrent, unfair and a waste of time, money and resources.

My wife is a Chronic patient who has undergone a triple heart bypass surgery, she also a diabetic and suffers from High blood pressure as your records would indicate. Her endocrinologist has stated that somehow recently, some treatments have not been paid. This is also extremely frustrating to the point of thinking of changing my Medical Aid itself, as i now have to find some money to pay the specialist for something that was covered before the downgrading was done.

I did speak to NOKU from the Dental Risk Company (Call ***) who confirmed that the next option with Specialized Dentistry would be the Value Platinum option, however this would depend on how much you have on your day to day Savings as Hosmed has gone this route. I therefore would request my Dentist to apply for Specialized Dentistry in April (2025). I also spoke Siphiwe or Smphiwe ( Call ***), who explained that, since there have been some "issues" or "challenges" with this transition and that partially why changing of Options has been extended until the end of March 2025. I however cannot wait that long and risk owing more money to the specialists who have taken great care of my family and this is why I chose to fill out the change of option form and send it as soon as possible.

Kindly notify me as to when this request of change of option would come into effect so that I can make better informed decisions and not get blidsided like I was this week.

Thanking you kindly

Harold Paton ***

Today 21 May 2025, I've just found (from my pharmacy) out that, Hosmed is refusing to pay for Victoza because they need a motivation from the specialist. Please note that they have my wife's whole chronic medication history. I spoke to the specialist and he said that they will send one - AGAIN- as soon as possible but they cant guarantee when this will be approved (or rejected) even though I've been with this medical aid for about 15 years and NOW they want approval. My wife's Victoza insulin will finish tomorrow.... Needless to say I'm angry and disappointed.

Let's see if they'll respond

my number is *** and I will post to update if there are some changes