EJ
Ebrain J

1 reviews | Active since Jul 2023

16 May 2024, 11:09

Short Payment on Pre-Approved Authorization provided.

I fail to understand how a medical aid scheme, who are receiving their money on a monthly basis (deducted from your salary) is not able to cover your hospital bill. I have never in my life been hospitalized or claimed from my Medical aid for operations, and now for the first time Sizwe is failing to settle my hospital bill submitted for payment. After pre-authorization has been provided to the Service provider they only paid 1/3 of the bill expecting me to settle double the amount they paid. How the payment process works is beyond me. I tried to get ahold of them for the past week with no success. I need clarification/explanation form them on why they short paid my bill. If this is not resolved I'm definitely moving away from this Scheme. This is a terrible experience, where I am afraid to get sick or go to a doctor fearing that they will not be paid for the service rendered. I need answers as the service form Sizwe is poor.

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Replies (6)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply16 May 2024, 11:32
Official
 Dear Ebrain, 

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. 
EJ
Ebrain J's update16 May 2024, 11:40
Reviewer Update
Dear Sizwe Team

***
*** or MHJ3887
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply16 May 2024, 11:59
Official
Received with thanks, Ebrain. 
We'll provide feedback soon. 
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply17 May 2024, 11:28
Official
 Dear Ebrain, 

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

Sizwe Hosmed. 
EJ
Ebrain J's update17 May 2024, 12:41
Reviewer Update
Dear Sizwe

This is super great. Thank you for resolving this matter so efficiently. This is much appreciated.
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply17 May 2024, 13:03
Official
You are welcome, Ebrain.