SIZWE... REALLY A DISSAPOINTMENT

Second time around..... Last year July 2018 we had to complain on this forum regarding my mom suffering health... Needs treatment and needs to be admitted for treatment. She received the neccessary auth shortly thereafter and could be admitted for treatment.

Only now that after she received the treatment APPROVED by Sizwe the medicine has been rejected as scheme exclusion and now the doctor/scriptwise wants to sue us for R39 693.16.

The authorisation received NEO ********** 2260A says that 3 Octogram treatments are approved. IT IS PRINTED ON THE AUTH RECEIVED!!! Now it is rejected as scheme exclusion.

We have followed this up on the 9th November 2018 and it was sent to the financial manager/department to be approved as the consultant said it should be paid as it was APPROVED and part of her hospital treatment.

Calling the call centre on Thursday 28th Feb 2019 to follow up again after we received the horrible phone call and notice regarding the payment I spoke to 2 consultants Nellie and Sibakasi that was great and really went out of their way to help us. Gave us a reference number to use to follow up, with the assurance that all communication could be seen regarding this claim as well as it was received on time and followed up

This claim was escalated to the financial department.... And Nellie was discussing and taking up with her manager to escalate the urgency of this unpaid account.

Phoning today to follow up NO ASNWERS... not even feedback on my ref number. And no help what so ever..... just coming back saying it is scheme exclusion... even after explaining that is is APPROVED ON AUTH..

Really Sizwe, my mom couldnt even have her further 2 treatments as needed and every day she loses more feeling in her legs and arms... Yet as well scriptwise will not help with the Octagram as no payment was made for the previous treatment

Now please.... what would you do, would this be pleasant if it was one of your family members that you had to struggle with??? would you be happy paying every month knowing that you have to worry about payment.

Please see the URGENCY of this matter as we dont have R40 000.00 and legal fees.

I ask your URGENT help in this regard