Misled by Umvuzo..pathetic service

To whom this may concern

Upon joining the medical aid my husband was misled by the people doing the roadshow as what they had stated at the time to pay for was not done. He did send an email to notify them of the problems we had been experiencing since we had joined the medical aid and he did not receive a response in finding a solution going forward. He had even emailed the broker and hr in January requesting that he please be taken off the umvuzo medical aid and put back to Discovery and that was not done and nor did we receive a response to that request. Changing to umvuzo medical aid was the biggeat mistake He ever could of made as being on this medical aid has made us incur more debt as doctors visits have not been paid. My son was ill and had to attend casualty and that was not paid. My wife fell sick on the 26 February 2023 and was taken to a gp who is on the umvuzo network. Upon examining my wife he said that she would need to go into casualty and he had given us a letter, we then went to St Augustines hospital and they found the need to admit my wife into hospital as she was experiencing excruciating headaches. They had done a brain ct scan and found that the course of the headaches was because of a blockage on the sphenoid sinus which needed to be drained. My wife was in hospital and was under alot of pain medication. I was told by the hospital that the case manager liases with the medical aid and gets authorization and approvals of stay because she had been admitted via casualty .Coming from Discovery i knew that it was done that way as with Discovery i did not need to contact the medical aid on my own to get any authorization once in hospital. My wife was then taken to theater and the operation was done. No one had mentioned anything about umvuzo not paying for sinus operations. After the procedure was done we the get a call from Bongani from Umvuzo who had every intention of putting a patient in more stress after just having an operation telling the patient that the sinus op is excluded. This created more panic for my wife who has now been getting more sick as this has turned out to be a bigger stress for her now by finding out that the medical aid does not want to pay. She then got discharged from the hospital and none of the discharge medication was paid for as stated that they would in the brochure. When the roadshow was done. They did not mention any of the exclusions and nor were we aware of there being any exclusions. This has now created problems between my wife and I as we cannot afford to pay the doctor for the procedure that was done and neither were we aware of the fact that the medical aid would not pay. Had I received a response to my request in January when I first started experiencing problems with Umvuzo then I wouldn't of been in this situation now. I did not have any problems with Discovery and was misled by the broker thinking that Umvuzo would be able to provide a better service and that was not done.

I need assistance in getting this matter resolved as I was never aware of any of the exclusions on Umvuzo as I was not told about it. My wife has been receiving calls from the doctors rooms and the hospital which has now compromsied her health due to all the stress. We have not been able to get any response from Umvuzo and are highly disappointed with the level of service we have received thus far. If this is not sorted out by Umvuzo then we will be taking the matter to the medical aid council in hopes of rectifying this situation as we are in no position to pay the doctors and pay the hospital and the surgery as Umvuzo is paying for nothing.