WS
Wilma S

1 reviews | Active since Feb 2023

20 Feb 2023, 13:00

Unresolved query from 2021

I am working for a provider who rendered a service to a Sizwe Hosmed member from 27/09/2021 until 11/10/2021. The member had quite a few claims that we had problems with. There were claims that needed to be amended as per scheme and this resulted in some claims being short paid and some claims being overpaid. I struggled for almost a year to get someone to just handle my query. I did however get through to someone, Jacqueline Mahlaba that assisted me in getting the overpaid amounts reversed, but I have still no luck getting my claims reprocessed to be paid in full for the period stated above. I have been sending emails every second week to Jacqueline Mahlaba as well as Nomsa Khoza from 3sixty health but with no reply or action on the accounts. I am now resulting to this review to see if there is someone else who can assist me as I do not know who to talk to, to get this paid. Please can someone assist me urgently regarding the processing of these claims. Dr J Mulla - My number is ***

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Replies (3)
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply20 Feb 2023, 13:12
Official
 Dear Wilma, 
 
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 
WS
Wilma S's update03 Mar 2023, 14:16
Reviewer Update
I have received a reply on this query on 20 February 2023 by Loyiso Nqeto and I have given the information requested but have since not had any further response from them. This is very disappointing indeed.
Sizwe Hosmed Medical Scheme
Sizwe Hosmed Medical Scheme's reply03 Mar 2023, 14:41
Official
Dear Wilma, 
 
Thank you for submitting the query, we sincerely apologise for the inconvenience caused. We we are working on your query.

Sizwe Hosmed team