Non payment and Rejected medical claims

Sizwe Hosmed was a good medicine aid and used to settle everything until 2024.

I was hospitalised in November 2024 and had an emergency c-section which required me to be put down . I was registered on the maternity program and had an approved pre-authorisation for the bed booking even spoke to one of the Consultants who said Netcare Femina is an approved DSP and there would be no co-payments.

Fast forward, 2025 January all the doctors, hospital and anaesthesiologist have not been paid yet. We are being told that the claims have been rejected. Which is crazy because got pre-authorisation and I was given the green light for admissIon.

If claims are going to be rejected months after the hospitalisation how are we supposed to pay for them? I had to transfer to a public hospital on my 3rd day of hospitalisation because I was scared that Sizwe would be problematic. It turns out they are.

I call in on Friday, 10th Jan to enquire about the rejected claim and the lady I spoke to told me that they are still working on the payments and that I should wait a week. Today I called in at the doctors offices and they still havent settled the bill.

It is disappointing to see that our hard earned money is heing sused to settle our accouts with medical providers and we are now required to settled almost 70 thousand rand in medical bills which we cannot afford.

I am even thinking of getting my lawyers involved in this. I dont want to be blacklisted because of this *********** medical aid.

How do I go about have my issues resolved I am tired of seeming like someone who doent honour their word.

I would bever recommend this medical aid to anyone!! It will leave you bankrupt!