INCONSISTENCY

<p>Before my baby's visit to the paediatrician on 28/12/2016, I contacted Sizwe twice(just to make sure as this is not the first time I get different information from different consultants) to ask if I need authorisation or a referral to take him as he is 9 and a half months old. I was informed NO, only after 12 months of age you need a referral from a GP. I was given a reference number.</p> <p>Then the account was not paid in full with reason code, no referral!!!! COME ON, this after being informed otherwise by 2 consultants.</p> <p>I made two calls to Sizwe on 03/01/2017 and 20/01/2017, explaining the situation, the consultants understood my query and agreed it was a mistake, they only need referral after 12 months of age and gave me reference numbers saying they will put the claim through again.</p> <p>Now today I phone and get informed that the claim will not be paid because he was older than 9 months!!! If I was informed on the 28th of December 2016 that I needed a referral, I would have gotten one, but was informed I DON'T. </p> <p>Last year I had a similar experience regarding vaccines. The one consultant tells me I can just go, I do not need authorisation, then afterwards I'm informed Sizwe does not cover vaccines at all?, although they covered some of the vaccines. Why not inform patients correctly when they phone in and help them in the right direction. </p> <p>This time I'm not accepting any stories, SIZWE will pay for this visit in full with the paediatrician and you can go and get your call recordings and listen to my conversations with your staff informing me.</p> <p> </p> <p> </p>