RM
Roshnee M
1 reviews | Active since Feb 2013
11 Feb 2024, 20:48
Unpaid claims
I sent through claims on the 25th of January and received an automated response that I would receive feedback within 3-5 working days. Nothing. Sent a follow up email on the 31st of January. Same response and no contact. Finally called the call center on the 1st of February and was told by Sindisiwe that my claims had not even been captured due to a backlog from December. Was advised that she would escalate and settle through for processing. Needless to say I have heard nothing further from Sizwe. I pay a hefty premium for my medical every month, over R6000. I do expect a better service. Could someone, anyone contact me to resolve this issue. My membership number is ***.
Helpful (0)
Replies (14)0
Replies (14)
Sizwe Hosmed Medical Scheme's replyOfficial
12 Feb 2024, 05:34 Dear Roshnee,
Thank you for submitting the query, we sincerely apologise for the inconvenience caused.
We will be in contact with you to resolve your complaint.
Sizwe Hosmed team
Thank you for submitting the query, we sincerely apologise for the inconvenience caused.
We will be in contact with you to resolve your complaint.
Sizwe Hosmed team
Sizwe Hosmed Medical Scheme's reply12 Feb 2024, 05:34
Official
Dear Roshnee,
Thank you for submitting the query, we sincerely apologise for the inconvenience caused.
We will be in contact with you to resolve your complaint.
Sizwe Hosmed team
Thank you for submitting the query, we sincerely apologise for the inconvenience caused.
We will be in contact with you to resolve your complaint.
Sizwe Hosmed team
Sizwe Hosmed Medical Scheme's replyOfficial
12 Feb 2024, 13:11 Dear Roshnee,
Thank you for the provided information.
Kindly note that the query has been escalated to the relevant department and feedback will be provided as soon as it is available.
Sizwe Hosmed team
Thank you for the provided information.
Kindly note that the query has been escalated to the relevant department and feedback will be provided as soon as it is available.
Sizwe Hosmed team
Sizwe Hosmed Medical Scheme's reply12 Feb 2024, 13:11
Official
Dear Roshnee,
Thank you for the provided information.
Kindly note that the query has been escalated to the relevant department and feedback will be provided as soon as it is available.
Sizwe Hosmed team
Thank you for the provided information.
Kindly note that the query has been escalated to the relevant department and feedback will be provided as soon as it is available.
Sizwe Hosmed team
RM
Roshnee M's updateReviewer Update
14 Feb 2024, 08:18Still waiting for feedback on this query. It's been 2 days
RM
Roshnee M's update14 Feb 2024, 08:18
Reviewer Update
Still waiting for feedback on this query. It's been 2 days
Sizwe Hosmed Medical Scheme's replyOfficial
14 Feb 2024, 08:55Dear Roshnee,
Thank you for your response.
Kindly be advised that we are working on your query. Feedback will be provided as soon as it is available.
Apologies for the inconvenience caused and thank you for your patience.
Sizwe Hosmed team.
Thank you for your response.
Kindly be advised that we are working on your query. Feedback will be provided as soon as it is available.
Apologies for the inconvenience caused and thank you for your patience.
Sizwe Hosmed team.
Sizwe Hosmed Medical Scheme's reply14 Feb 2024, 08:55
Official
Dear Roshnee,
Thank you for your response.
Kindly be advised that we are working on your query. Feedback will be provided as soon as it is available.
Apologies for the inconvenience caused and thank you for your patience.
Sizwe Hosmed team.
Thank you for your response.
Kindly be advised that we are working on your query. Feedback will be provided as soon as it is available.
Apologies for the inconvenience caused and thank you for your patience.
Sizwe Hosmed team.
Sizwe Hosmed Medical Scheme's replyOfficial
16 Feb 2024, 09:37Dear Roshnee,
Kindly note that a request has been submitted via the provided email.
Kindly attend to the request so that we assist accordingly.
Sizwe Hosmed team.
Kindly note that a request has been submitted via the provided email.
Kindly attend to the request so that we assist accordingly.
Sizwe Hosmed team.
Sizwe Hosmed Medical Scheme's reply16 Feb 2024, 09:37
Official
Dear Roshnee,
Kindly note that a request has been submitted via the provided email.
Kindly attend to the request so that we assist accordingly.
Sizwe Hosmed team.
Kindly note that a request has been submitted via the provided email.
Kindly attend to the request so that we assist accordingly.
Sizwe Hosmed team.
RM
Roshnee M's updateReviewer Update
16 Feb 2024, 10:12To Whom It may Concern,
Request has been attended to and documentation sent., I await your feedback.
Request has been attended to and documentation sent., I await your feedback.
RM
Roshnee M's update16 Feb 2024, 10:12
Reviewer Update
To Whom It may Concern,
Request has been attended to and documentation sent., I await your feedback.
Request has been attended to and documentation sent., I await your feedback.
Sizwe Hosmed Medical Scheme's replyOfficial
16 Feb 2024, 10:33Noted with thank you.
Feedback will be provided as soon as it is available.
Sizwe Hosmed team.
Feedback will be provided as soon as it is available.
Sizwe Hosmed team.
Sizwe Hosmed Medical Scheme's reply16 Feb 2024, 10:33
Official
Noted with thank you.
Feedback will be provided as soon as it is available.
Sizwe Hosmed team.
Feedback will be provided as soon as it is available.
Sizwe Hosmed team.
RM
Roshnee M's updateReviewer Update
20 Feb 2024, 08:45It's going for almost a month now. How long does it take to pay 2 claims which were submitted on the 25/01. Additional documentation was submitted on the 16/02 as requested and I am still waiting. Today is the 20/02??
RM
Roshnee M's update20 Feb 2024, 08:45
Reviewer Update
It's going for almost a month now. How long does it take to pay 2 claims which were submitted on the 25/01. Additional documentation was submitted on the 16/02 as requested and I am still waiting. Today is the 20/02??
Sizwe Hosmed Medical Scheme's replyOfficial
20 Feb 2024, 10:41Feedback is provided via email.
The query is closed.
Sizwe Hosmed team.
The query is closed.
Sizwe Hosmed team.
Sizwe Hosmed Medical Scheme's reply20 Feb 2024, 10:41
Official
Feedback is provided via email.
The query is closed.
Sizwe Hosmed team.
The query is closed.
Sizwe Hosmed team.
RM
Roshnee M's updateReviewer Update
20 Feb 2024, 11:52 Dear Dineo,
I am not happy with the outcome. The gastroenterologist did not submit this account for payment. I made the payment and submitted to the medical aid. I can understand if you are claiming that the lab claim is rejected as they did submit the account to the medical aid.
According to Sizwe rules a member can claim provided the claim is within 3 months of treatment . I want this escalated to a higher authority. I am not happy and this query is not closed. I am reverting back to hello Peter to reopen this query.
Mrs R Moon
RM
Roshnee M's update20 Feb 2024, 11:52
Reviewer Update
Dear Dineo,
I am not happy with the outcome. The gastroenterologist did not submit this account for payment. I made the payment and submitted to the medical aid. I can understand if you are claiming that the lab claim is rejected as they did submit the account to the medical aid.
According to Sizwe rules a member can claim provided the claim is within 3 months of treatment . I want this escalated to a higher authority. I am not happy and this query is not closed. I am reverting back to hello Peter to reopen this query.
Mrs R Moon
RM
Roshnee M's updateReviewer Update
20 Feb 2024, 11:53If it was possible to give Sizwe a -1 that's what you would be rated .
RM
Roshnee M's update20 Feb 2024, 11:53
Reviewer Update
If it was possible to give Sizwe a -1 that's what you would be rated .
RM
Dear Valued Member
Thank you for your request/query.
Our customer service team is now looking into your query.
A more substantive response to your problem and a suitable solution will be provided to you within 3-5 business days.
Your choice for quality care,
Sizwe Hosmed Medical Scheme
Roshnee M's updateReviewer Update
20 Feb 2024, 16:56Dear Valued Member
Thank you for your request/query.
Our customer service team is now looking into your query.
A more substantive response to your problem and a suitable solution will be provided to you within 3-5 business days.
Your choice for quality care,
Sizwe Hosmed Medical Scheme
I await your feedback
RM
Roshnee M's update20 Feb 2024, 16:56
Reviewer Update
Dear Valued Member
Thank you for your request/query.
Our customer service team is now looking into your query.
A more substantive response to your problem and a suitable solution will be provided to you within 3-5 business days.
Your choice for quality care,
Sizwe Hosmed Medical Scheme
I await your feedback
RM
Roshnee M's updateReviewer Update
21 Feb 2024, 13:22I still have not received feedback. I have reported Sizwe to ombudsman for medical services.
RM
Roshnee M's update21 Feb 2024, 13:22
Reviewer Update
I still have not received feedback. I have reported Sizwe to ombudsman for medical services.
RM
Roshnee M's updateReviewer Update
21 Feb 2024, 13:24Thank you for contacting the Office of Health Standards Compliance on 20/02/2024 18:00.Your ticket has been logged with ID ***.
We hereby acknowledge receipt of your complaint, contents of which are noted. In terms of the National Health Amendment Act, 2013 (Act No. 12 of 2013) the Office has a duty to investigate all complaints relating to breaches in norms and standards in a procedurally fair, economical and expeditious manner.Kindly note that the Office will process your complaint and revert back to you as soon as possible.Yours faithfully,
Mr K.D Simelane
OHO Call Centre Team Leader
Dr Siphiwe Mndaweni – CEO |Mr. Julius Maphata: Chief Financial Officer
Complaints
***
www.ohsc.org.za
This e-mail and its contents are subject to the Office Of Health Standards Compliance e-mail disclaimer available at https://ohsc.org.za/ohscs-e-mail-disclaimer/
We hereby acknowledge receipt of your complaint, contents of which are noted. In terms of the National Health Amendment Act, 2013 (Act No. 12 of 2013) the Office has a duty to investigate all complaints relating to breaches in norms and standards in a procedurally fair, economical and expeditious manner.Kindly note that the Office will process your complaint and revert back to you as soon as possible.Yours faithfully,
Mr K.D Simelane
OHO Call Centre Team Leader
Dr Siphiwe Mndaweni – CEO |Mr. Julius Maphata: Chief Financial Officer
Complaints
***
www.ohsc.org.za
This e-mail and its contents are subject to the Office Of Health Standards Compliance e-mail disclaimer available at https://ohsc.org.za/ohscs-e-mail-disclaimer/
RM
Roshnee M's update21 Feb 2024, 13:24
Reviewer Update
Thank you for contacting the Office of Health Standards Compliance on 20/02/2024 18:00.Your ticket has been logged with ID ***.
We hereby acknowledge receipt of your complaint, contents of which are noted. In terms of the National Health Amendment Act, 2013 (Act No. 12 of 2013) the Office has a duty to investigate all complaints relating to breaches in norms and standards in a procedurally fair, economical and expeditious manner.Kindly note that the Office will process your complaint and revert back to you as soon as possible.Yours faithfully,
Mr K.D Simelane
OHO Call Centre Team Leader
Dr Siphiwe Mndaweni – CEO |Mr. Julius Maphata: Chief Financial Officer
Complaints
***
www.ohsc.org.za
This e-mail and its contents are subject to the Office Of Health Standards Compliance e-mail disclaimer available at https://ohsc.org.za/ohscs-e-mail-disclaimer/
We hereby acknowledge receipt of your complaint, contents of which are noted. In terms of the National Health Amendment Act, 2013 (Act No. 12 of 2013) the Office has a duty to investigate all complaints relating to breaches in norms and standards in a procedurally fair, economical and expeditious manner.Kindly note that the Office will process your complaint and revert back to you as soon as possible.Yours faithfully,
Mr K.D Simelane
OHO Call Centre Team Leader
Dr Siphiwe Mndaweni – CEO |Mr. Julius Maphata: Chief Financial Officer
Complaints
***
www.ohsc.org.za
This e-mail and its contents are subject to the Office Of Health Standards Compliance e-mail disclaimer available at https://ohsc.org.za/ohscs-e-mail-disclaimer/