MC
Mariette C

1 reviews | Active since Jul 2012

16 Sept 2022, 17:10

Terrible claim service

I am assisting my elderly father who is getting very poor service from Sizwe. He recently went for an operation for which he did get the appropriate authorizations beforehand. He went to an associated hospital for the operation and made sure everything was in order on all fronts. His bills are not being covered for the operation, the reasons being many inaccurate excuses. For one, he went to Life Wilgers Hospital but because the invoice had a heading where Life and Wilgers Hospital were on two different lines, the claim was refused because it wasn't on the list of associated hospitals. That was corrected, but now there is another excuse not to pay. The surgeon is not getting paid, the anesthesiologist is not getting paid, the wound nurse is not getting paid. My father is paying a high premium for care that he is expecting, but not getting from the medical aid. I would like to sort this out as soon as possible.

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Replies (4)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply16 Sept 2022, 17:52
Official
Dear Mariette, we acknowledge your complaint  and sincerely apologise for this frustration. Can you please give us till Monday morning to contact you and sort this out for you. Sizwe Hosmed team.
MC
Mariette C's update19 Sept 2022, 11:56
Reviewer Update
Thank you, please do, my father is expecting your call.
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply19 Sept 2022, 12:39
Official
Dear Mariette, kindly note that we were able to reach your father on the telephone. We will indeed assist and resolve the query. Again, we do apologise for the inconvenience caused.

Sizwe Hosmed team. 
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply26 Sept 2022, 13:00
Official
Dear Mariette, Kindly be advised that the claim was reprocessed for this week’s payment run.

Sizwe Hosmed team.