DM
Dr M

1 reviews | Active since May 2017

01 May 2017, 19:50

Unpaid OH consultation claims

<p><br />I am not at all happy about the way i am being treated by your customer service consultants. I have been struggling for the past 3 months with a ****** simple query. if this matter is not sorted out i am going to the ombudsman and i will contact someone from the media to cover my story. I was told i need to update my details on your new system because of the whole systems migration implementation. i battled for 1 month to get my details updated. then when they were updated i was told will receive payments on a specific date then that date changed. honest to God you need to find a new administrator to do things right because i honestly feel momentum is struggling or maybe their consultants are ***********. Is this the thanks i get for treating your members out of hospital so that they won't get admitted in-hospital!!!! i am not even requesting for these claims to covered from risk as a PMB as his diagnosis is a PMB condition!!!! i am ****** claiming from the member's medical savings account. please some one sort out my query of unresolved claims for January and February.</p> <p>I have spoken to multiple agents regarding this matter!!!! I can only remember a few names:<br />Luzoko Nzuzo (TL's name Dimakatso from the GP branch)<br />Desire du Plesis <br />Dumeleni Duma (from the KZN walk-in center)</p> <p>Please coach these agents on FCR!!!! among the three agents i have been told different stories. They have been all absolutely useless and none of them have done a follow-up to find out if my query has been resolved!! they all USELESS!!<br />My claims should reflect on your system so please dont irritate me and ask me the dates of service. none of my 2017 claims have been paid!</p> <p>i hope someone will be in contact with me soon regarding this. if i dont get a response in a week i will escalate this to the ombudsman!! </p>

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Replies (1)
Transmed
Transmed's reply12 May 2017, 10:57
Official

Good day

Payments have been made although the provider did not receive payment in his bank account. We have received confirmation that the provider banking details are correct. We are investigating the reason why the payment was not received in his bank account.

Not all claims were paid due to benefits exhausted.

We are engaging with the provider.

Kind regards