SN
Samuel N

1 reviews | Active since Jun 2024

15 Jun 2024, 19:05

Unpaid Claims!!!

My mother went for a hip replacement in February and both the doctor and the hospital got full authorization prior to the procedure otherwise the hospital would not have admitted her. Post the operation Sizwe has been giving both the doctor and the hospital the run around and not paid them. The doctor recieved less than a 10% payment and suddenly there are all kinds of excuses like the doctor used the wrong codes to claim etc. My mother is 82 years old and have been paying her contributions diligently for all these years to now be treated like this by a medical aid for a first major procedure in all her life. Its a disgrace. She feels embarrassed to go to the doctor for aftercare as his fees has not been settled. Do you honorable thing Sizwe and settle legitimate claims. What more do you need as the evidence that she had the operations. Shame on you!!!!

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Replies (3)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply16 Jun 2024, 09:09
Official
Dear Samuel, 

Thank you for submitting your query and apologies for the inconvenience caused. 
Kindly share the query's reference number so we can investigate and escalate it to the claims department for urgent attention. 

We appreciate your patience. 

Sizwe Hosmed team. 


Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply18 Jun 2024, 10:12
Official
Good day, Samuel. 

We have tried to reach the provided telephone number to no avail. 
Kindly share the query's reference number so we can investigate and escalate it to the claims department for urgent attention. 
 
SN
Samuel N's update24 Jul 2024, 12:50
Reviewer Update
SThe ref no WF***6N***4. Sizwe still playing games. They make issues of incorrect codes use by doctors etc and dont settle the doctor or hospital in full. Please contact me rather on number *** for any further info or questions. They vcant get away with this. they are causing psycolocial issues to my 83 year old mom by doing this and treating us badly.