DF
Denise F

1 reviews | Active since Sept 2018

22 May 2024, 15:42

Not paying as per Membership guide

I am very upset with this medical aid. After numerous calls and emails, waisting my time and money, I still don't get proper feedback with valid reasons why my claim is rejected. I went for a mammogram in March 2024. The claim was rejected, with reason being that I only qualify for mammogram benefit every two years, which I am fully aware of. I go for a mammogram every year as it was recommended by the treating practitioner. I wanted to make use of my "Wellness benefits" as described in the Membership guide for 2024 on page 39. It states that I can go for a mammogram, if over 40 years of age, per annum (yearly). I am currently 51 years. All my emailed queries gets back with the response that this issue was resolved, which it's not. Even with my calls they keep telling me that I only get mammogram 2 yearly. I even send a screenshot to them of the proof that it is in the Membership guide. Still no answer/payment/response. In the meantime the provider is urging my to pay the account as this account is going for almost three months overdue. I decided to log a complaint with CMS (Council for medical schemes) and awaiting their response. Hopefully this will get my account settled.

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Replies (3)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply22 May 2024, 15:49
Official
Dear Denise, 

Thank you for submitting your query and apologies for the inconvenience caused. 
 Kindly provide the membership number and reference number of the query so that we can investigate and escalate it to the claims department for urgent attention. 

We appreciate your patience. 

Sizwe Hosmed team. 
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply24 May 2024, 11:31
Official
Dear Denise, 

 We're glad to inform you that the claim has been reprocessed for next week's payment run. 
 The query is closed. 

Sizwe Hosmed. 
 
DF
Denise F's update31 May 2024, 05:45
Reviewer Update
Good day. Please confirm if payment was done, as promised for this week? I haven't received statement for this payment yet?