SIZWE MEDICAL AID REFUSES TO PAY FOR DOCTORS VISIT ADVANCING FRIVOLOUS REASONING

SO REPORTED A PROBLEM FROM 1ST JUNE 2020 REGARDING THIS MEDICAL AID SIMPLY REFUSING TO HONOUR ITS OBLIGATIONS. INITIALLY CLAIM SHORT PAID AND TOLD THE REASON WAS THAT THE SPECIALIST VISIT WAS NOT AUTHORISED. SENT THEM PROOF OF AUTHORISATION. HUH !!!! NEW REASON ADVANCED. USED THE INCORRECT CODE ON DOCTORS INVOICE. HUH!!! RESUBMITTED INVOICE WITH THE CODE STIPULATED EVEN THOUGH THE SAME SPECIALIST HAS BEEN CLAIMING USING THE VERY SAME CODE. YOU GUESSED RIGHT - SUBMITTING DUPLICATE INVOICE...INVOICE REJECTED...CALLED CALL CENTRE...AGREE WITH ME AND WILL SORT IT OUT...STILL HAVE'NT...ESCALATED THE PROBLEM...INFORMED THAT THE MATTER IS BEEN ATTENDED TO ...10 DAYS AGO...POOR SERVICE..HAVE TO NOW TAKE THIS TO THE MEDICAL AID OMBUDSPERSON BECAUSE THEY SIMPLY REFUSE TO HONOR THEIR OBLIGATIONS