Pathetic service from Sizwe Hosmed for long-standing members!

I have been a member of the SizweHosmed Medical Fund since 2002. I was also employed at Sizwe Medical Services since 1995. I was on Gold Ascend option for many years and towards the end of 2023, I sent in a list of questions pertaining to the “new” Option that I wanted to change over to since the option I was on would be too costly to continue on in 2024. The option I had selected to change to was the Silver Hospital Plan but I was told that this Option would be discontinued in 2024. I was recommended the Savings OR the Essential Copper Options. I drew up a list of questions mainly relating to our Chronic conditions and our Care Plans as this was of great concern to me. I sent these questions on 13 December 2023, before deciding to change Options. I waited a while and followed up. I was told that everyone was very busy, and they would get back to me soon. I had also written an email to the membership manager on 21 November 2023 with some questions and she responded that MHC (Managed Health Care) confirmed that the Care Plans and the Chronic Medication schedules would be carried over to the new Plans/Options. She had referred my list of questions to the Clinical Department for clarification but to date, I have received NO RESPONSE! On 26 December 2023, with the deadline for Option Change fast approaching, I was compelled to confirm that we would change Options to Essential Copper. Now my main problem occurred when my husband became ill and was referred by our GP to our Gastroenterologist on 05 August 2024. Our gastroenterologist is a Network Provider & he requested hospital authorization to admit my husband to hospital for a Colonoscopy and Endoscopy. This authorization was Denied because it was not a PMB condition. It was only then that we were informed Copper Essential pays ONLY PMB treatment in hospital. We spent hours at the doctor`s rooms and at the hospital, waiting for an authorization. Both of us being Diabetic and Cardiac patients, it was a stressful and hungry wait. I was most upset and humiliated when I was told by the person in charge of the Auth Department that I should have never changed my Option, KNOWING that it caters ONLY for PMB and it caters for the Young and Healthy Members! Yes, we are Pensioners now, but we were once young and healthy too and paid our dues by the "Young Sponsoring the Elderly" as she put it to me! Her view should have been conveyed to me back in November 2023 when I first enquired about an option change. This is NO WAY to speak to their Members! We returned home totally dispirited and unhappy! Had we known this option was only for PMB conditions, we would not have changed our Option. Maybe we would have left the Fund altogether! How could the Specialist admit my husband for a PMB condition without performing the Scopes and Diagnosing the Condition? Is he supposed to "Thumb Suck/Guess" the Diagnosis? Surely the "PMB Rule" should only be app**** after a Diagnosis is confirmed? After all, PMB is determined by the Diagnosis! I wrote an email to the Queries and Authorisations departments explaining the situation and how I went about Changing Options. I was sent an automatic response that my query will be looked at. Following this response ten days later, I sent another email and received the same automatic response. I then wrote to the Principal Officer of the Fund, Ms N Tshobeni. She responded immediately, stating she will follow up. I waited a further 9 days and sent another email to the Queries and Auth departments as well as to Ms N Tshobeni. I received another automatic response that my query is Resolved! I wrote immediately asking if the Auth has been approved and requesting the Auth Number. This email did not get responded to. I also received a response from Ms Tshobeni stating I should allow her time to get the matter sorted as she has contacted the Administrator. Thereafter I received an email from the Auth department with the response, "Auth Rejected". A further 10 days later I sent another email to Ms Tshobeni and stated that I have not received a response from her, and I will be lodging a complaint with CMS as I am unhappy with the time lapse while my husband is in pain and discomfort all this while. Even though I acted responsibly and asked pertinent questions relating to our health conditions BEFORE I changed Options, I was NOT given clear, concise or correct information in order for me to make the correct decision. Now I am being expected to pay the Penalty for their Incompetence. It appears as though the staff at SizweHosmed were not trained in the New Options and handled the queries inappropriately. Moreover, when I eventually received the Brochure in January 2024, I was sufficiently satisfied that the Scheme will cover our health conditions. Below is what I read regarding the Hospital benefit. ALL ADMISSIONS (including PMBs) does NOT tell me that its ONLY PMBs! Excerpt from the Benefit Guide: "Hospital Admission (Intensive Care, High Care, General Ward, Theatre and Recovery Room) All admissions (including PMBs) are subject to pre-authorisation…." The word out in the marketplace is that Sizwe did not carry out their due diligence strictly and did not budget for the debt they took on when they amalgamated with Hosmed. Hence, they are in difficult straits now! And we, the Sizwe members are having to bear the brunt of their negligence!