Pathetic - no response to communication or complaints.

I posted the review below on 12 October. To date, neither I nor the provider in paragraph 1 below received any feedback regarding this claim with reference number ***.

I have now also been sent ANOTHER fat account by a different provider pertaining to the same hospital stay mentioned in paragraph 1 below. They say they never received payment from Sizwe Hosmed despite trying to follow up for months.

in paragraph 2 below, my request for a call back regarding other options has still not been fulfilled. I received an email regarding the account in paragraph 3 below that I submitted for refund stating benefits exceeded. The claim should have been refunded since it is for a chronic PMB condition registered on a care plan with two consultations allowed per annum. I replied saying the account needs to be re-processed using the relevant information which was all provided in every email but once again, radio silence! ***

This is the kind of pathetic service that Sizwe members have become accustomed to.

I have been a Sizwe Hosmed member for many years now and the service has gone from bad to worse. This particular complaint is regarding three separate issues:

1. My daughter was hospitalised in May 2026, we obtained authorisation for the hospital stay. We have been receiving calls for shortpaid accounts, the latest being a cardiologist. When I called Sizwe on 5 October to follow up, I was told that the provider must send an email to the authorisations department to add the codes they claimed to the existing hospital authorisation and must then be re-submitted and it will pay out. I asked the provider's accounts department to do that but they said they tried that without success. They say they were told previously that it rejected due to us not being on a plan that covers the codes in hospital which was very surprising to both myself as well as the customer service consultant who assisted me. I called a second time on 6 October and was told the claim must be sent to the case management department to add the codes to the hospital authorisation and re-submitted for payment, again no response has been received. Call ***

2. During my first call on 5 October, I requested information on other Sizwe Hosmed's other options. I was told that a callback had been requested. To date, I have received no call from anyone.

3. I submitted an account for a refund on 6 October, it has not been captured as yet. We pay a packet for medical aid contributions and always end up out of pocket thanks to Sizwe Hosmed. Ref: ***