Thokozani K

Disgusting Dishonest Service

Absolutely appalling service from the claims agent called Zandile in the claims department and even worse service from her team leader who cam on the call to address me after Zandile clearly didn't know what the hell she was doing. I have been trying to get my chronic meds for the past 2 weeks (major depressive disorders patient) without any luck. My meds were out of formulary. I called and the chronic department said all is well on theie side, I just need Dr or the Pharmacy to call claims department and they would fix it. Pharmacy struggled to get through the whole week. Eventually I decided it's 2 weeks without meds now, I'm gonna loose it. So I call to get a direct number so the pharmacist can call on it and be able to facilitate me getting my meds. I get to Zandile. She doesn't know what she's doing, putting me on hold after every paragraph, you can hear someone coaching her in the background for 23mins of the call. She told me Iust go online and look up if my medication is covered on the plan and ask Dr to get generics. It wasn't the first time getting these meds, what has changed now that my med aid doesn't cover them all of a sudden??? So i ask for a supervisor and she tellsw he won't be available because it's after 5 and they close at 5. I've worked at contact centre for a bank before, I know team leaders can't leave before all agents have logged off and I tell her I need to speak to him. He comes on the line with an attitude and doesn't wait for me to relay my concern to him, instead he TELLS ME what my query is and because Im on the lowest plan I need to take generics for my medical aid because they are not covered. They change every year in July so it might have been covered but now it's not. I started taking these meds around Oct Nov last year, it hasn't even been a year since I took them and all of a sudden they are not covered now again. I took them on January again but in March they are not covered? He said I must go to a very long list on the Medscheme website (he acknowledges that it's extremely long, mind you) and see that my medication is not there and tell my Psychiatrist to prescribe generis because my plan, the lowest plan, doesn't cover this. I hung up on him. And told the pharmacy to call again. The pharmacy lady spoke to me today and said it was utter ******* what I was told. She went through to Wendy and she said they a lower dose of the meds was approved and because it is now adjusted, they needed to re-approve. And my meds just went through and the claim clocked into my email. The generic bull**** was just that to get me off the phone. Well they need to be held accountable for incorrect information about to a client. I'm not donating to the scheme, I'm paying hard earned money. This is the first complain, the next one is with the scheme complains department. I want them to be brought to book. May they never so this again to someone else who is already battling a chronic condition.