My claims rejected because of wrong Tariff Codes yet consultants can't provide me with a list of correct tariff codes

Item: Sizwe Hosmed Medical Scheme
Rating: 1
Author: Rachel W

I am a provider who delivered a service to a Sizwe Hosmed patient on 28 February, and different dates thereafter. It's my first time encounter with Sizwe Hosmed. From my experience so far, I will never deliver a service again to one of its members. I submitted my seperate claims and every time when I contact the call centre, consultants tell me my claims cannot be found on the system despite me providing them with reference numbers for each claim. The next time I called they informed me my claim was rejected because I indicated no tariff codes on the claims. So I asked the consultant where can I find the tariff codes because I don't see any list on the website. I am told they can't open the system to see which tariff codes. So I keep on calling almost every day and is provided with a new escalation reference code. However, until this day my claims are not processed and I still don't know where I can find the list of tariff codes. What's even more pathetic, is that each consultant I spoke to, doesn't even know what tariff codes are. I have so many reference nr's that I am confused by now. For each medical aid, the tariff codes for Psychologist is the assessment and counselling time spent with a client and the amount which can be billed for it. Sizwe Hosmed consultants doesn't know what tariff codes are but yet they tell me I must indicate the correct tariff code on my claims and they will process it. This is the worst experience I had with a medical aid scheme.

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Replies (2)

Sizwe Hosmed Medical Scheme's replyOfficial

02 Apr 2024, 05:11

Dear Rachel,

Thank you for the provided details.
Kindly be advised that we are working on your query and feedback will be provided as soon as it is available.

Apologies for the inconvenience caused and thank you for your patience.

Sizwe Hosmed team

Sizwe Hosmed Medical Scheme's reply02 Apr 2024, 05:11

Official

Rachel W's updateReviewer Update

04 Apr 2024, 12:59

I have been contacted by a representative of Sizwe Hosmed who send me a wrong Tariff code list for a different registration designation. I brought it under her attention and she indicated that she will send the correct Tariff codes list as soon as she receives it. Almost two days has passed and I am still waiting for the Tariff codes list. It's been more than a month since I have submitted and resubmitted my claims to Sizwe Hosmed. I am. Just wondering, how many Providers claims are rejected daily because of wrong Tariff codes which is nowhere to be found on the website. Why is there no transparent list of Tariff codes for Registered Counsellor Counsellors, Psychometrist and Psychologist available on the Sizwe Hosmed website. The standard reply when I call in weekly for the past month about the status of my claims, is the system don't want to open the Tariff codes. One thing that I have noticed from the wrong Tariff codes list (for Psychologist) that I received, is there was no duration length of the assesment and consultation. How is the provider supposed to know which code to use if there is now duration of asessment and consultation? How does the assessors evaluate claims and reject it when it seems there is no Tariff codes list available? I am just wondering, is there a Tariff Code list for Registered Counsellors at Sizwe Hosmed? Are claims just automatically rejected for Registered Counsellors for the simple reason that the scheme does not want to payout? 🤔

Rachel W's update04 Apr 2024, 12:59

Reviewer Update