Incompetency at Sizwe Medical Fund

Sizwe Medical Fund does not even deserve a star. Their service with regards to processing and settlement of claims are shocking and the staff working there are clearly *********** and need training!

It started last year when accounts were submitted by various service providers for medical treatment my father received during his hospitalization. Although the claims were linked to my father's hospitalization authorization number and dates during his admission in hospital, Sizwe settled the claims from the day-to-day benefits. Suddenly my pensioner parents had to pay from their own pocket for doctors visits, over the counter medication, blood tests, etc. as they were informed that their benefits were exhausted.

I started investigating these claims and contacted Sizwe to discuss all the claims and settlement thereof. That is when I came to the discovery that Sizwe settled the claims from the incorrect benefit. My question was then: Can't they read as the claims claerly stared the hospotal detail? What a mission of 3 months it was to get Sizwe to rectify the claims they settled from the day-to-day instead of the hospitalization benefit and still a mission it is as not all claims have been settled.

I spent more than 200 minutes in calls to Sizwe, a lot of time typing e-mails enquiring with regards to claims to Sizwe but they will not even offer to call you back. My parents also had to spend hours calling Sizwe. They pay their monthly instalment on time but do not get the service they deserve!

I am now still struggling that Sizwe settle a claim of 27 December 2018. The claim was sent in by die service provider to Sizwe and was at first rejected due to 'benefits exceeded'. After Sizwe rectified the in-hospital claims, I submitted this claim again and they settled it only partially in January 2019. I again submitted the claim early February 2019 stating clearly that the claim was only partially settled and indicated to Sizwe what was not settled by them. At first I was informed that the claim will be resent for processing and soon thereafter informed that the claim is rejected with reason 'duplicate claim'. My mother called Sizwe last week with regards to this claim, receiving confirmation during this call that there is available day-to-day benefits, and soon thereafter I received an e-mail requesting that the claim be sent in as a paper claim. I contacted the doctors rooms and they immediately submitted a paper claim quoting the reference number Sizwe provided. You will be shocked to hear that I then received an e-mail from Sizwe with a statement attached stating that the claim was settled in January 2019. Clearly I am dealing with *********** Sizwe staff that cannot even interpret their own statements they send to their members.

Where is the service they are supposed to deliver? Do not even dare to ask to speak to the Team Leader, as you are told she is either not currently in the office, or unavailable, or in a meeting and they just do not provide you with her contact number or e-mail address. This makes me wonder if such a person even exists at Sizwe. There is a procedure to follow to lodge a complaint at the medical aid, and this entails that you come in contact with a Team Leader and if you are then not happy with the outcome, a complaint may be lodge with the Council for Medical Schemes. How can I lodge a complaint to solve this if I am unable to follow the first step to lodging a complaint? I am also certain that an e-mail to Sizwe to lodge a complaint will only fall on deaf ears and most probably be ignored. I searched on the world wide web with regards to lodging a complaint to Sizwe and the page of complaints do not load / open - just a blank page. Could have guessed...

Sizwe should be ashamed to let unsettled claims escalate like this without resolving the matter!!!

I should send Sizwe an account for the cost of both my parents and my own telephone calls.