Service delivery sizwe medical aid

I am writing to express my deep dissatisfaction with the handling of a chronic medical claim submitted on behalf of my 74-year-old grandmother. The experience has been nothing short of exhausting, confusing, and deeply disappointing.

In early 2024, I contacted your service regarding a chronic medication claim. I was explicitly informed that the medical aid would only cover a two-month supply, and any additional medication would need to be purchased in cash. This was understandable, as my grandmother was set to travel abroad for six months starting in May.

Upon her return in November, I immediately followed up and submitted all the required documentation. At no point during my initial interaction was I told that claims must be submitted within 90 days. Had I been made aware of this, I would have ensured that all relevant receipts and documentation were collected and submitted before her departure.

Since November, I have contacted your office numerous times and sent several emails, each time receiving different instructions and contradictory information. Finally, in April, I was told the claim would not be paid due to it being outside of the 90-day claim period.

This is unacceptable.

The lack of clear communication from your team has directly led to this issue. We were never properly informed of the time limits, despite making a proactive effort to understand the process and requirements. As a result, we were misled, and my grandmother was left without compensation for essential medication that we paid for out of pocket.

This is not just a matter of poor service – it is a failure in duty of care. We feel misinformed, dismissed, and unsupported throughout this process.

I demand that this case be escalated for urgent review and reconsideration. The fault lies with the guidance we received from your team, and it is unfair that your miscommunication should result in a financial loss for a pensioner relying on vital medication.