Sisonke Health Medical Scheme
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#7
in Wellness & Beauty
NPS Score
0
Recommended: Unlikely
May '25 - Apr '26
Used this business recently? Share your experience to help others decide.
Used this business recently? Share your experience to help others decide.
Share Your Experience1 reviews | Active since Jan 2020
If you are an employee of Momentum Tyb(Ltd) and Sisonke Health Medical Scheme,you got paid salaries+ bonuses in December 2025 and a salary in January 2026,have a moment of silence for Healthcare Providers and their families because they have not had claims paid. The members have confirmed that Sisonke Medical Scheme still exists because they debited their monthly premiums in January 2026 and Momentum Tyb is still administrating for Sisonke Health Medical Scheme because when I phoned their PE offices i was given all sorts of excuses as to why claims were not paid.From blaming EDI etc.When this did not make sense i requested to speak to the team leader(Karen) who was the one advising the front desk lady,i was told that all of the sudden she was not available.So much for Accountability!Momentum Pty (Ltd) why are you playing mind games with our businesses?What is really going on between your business and Sisonke Health Medical Scheme? Credible administrators i.e Medscheme sent out notifications to explain why claims were not paid from the 1-19 January 2026 and true to their communication claims were settled on the 20January 2026.Your company does the duck and diving instead of being accountable. Some specialists report 0claims being paid for 2026,1GP despite submitting more than 15 claims in January got paid for 1X claim of December 2025 in January 2026 and my business has more than 50 claims for January 2026 not paid and EDI have submitted them a long time ago. Has the amalgamation between Sisonke Health Medical Scheme and Lonmin Medical Scheme affected the services provided by Momentum Tyb like payments of claims.Even so the communication with their claims dept did not suggest so.
1 reviews | Active since Jan 2020
If you are an employee of Momentum Tyb(Ltd) and Sisonke Health Medical Scheme,you got paid salaries+ bonuses in December 2025 and a salary in January 2026,have a moment of silence for Healthcare Providers and their families because they have not had claims paid. The members have confirmed that Sisonke Medical Scheme still exists because they debited their monthly premiums in January 2026 and Momentum Tyb is still administrating for Sisonke Health Medical Scheme because when I phoned their PE offices i was given all sorts of excuses as to why claims were not paid.From blaming EDI etc.When this did not make sense i requested to speak to the team leader(Karen) who was the one advising the front desk lady,i was told that all of the sudden she was not available.So much for Accountability!Momentum Pty (Ltd) why are you playing mind games with our businesses?What is really going on between your business and Sisonke Health Medical Scheme? Credible administrators i.e Medscheme sent out notifications to explain why claims were not paid from the 1-19 January 2026 and true to their communication claims were settled on the 20January 2026.Your company does the duck and diving instead of being accountable. Some specialists report 0claims being paid for 2026,1GP despite submitting more than 15 claims in January got paid for 1X claim of December 2025 in January 2026 and my business has more than 50 claims for January 2026 not paid and EDI have submitted them a long time ago. Has the amalgamation between Sisonke Health Medical Scheme and Lonmin Medical Scheme affected the services provided by Momentum Tyb like payments of claims.Even so the communication with their claims dept did not suggest so.
1 reviews | Active since Jan 2020
On 28 August 2025 a claim for Dr R van Wyk was rejected because it was submitted in duplicate. On 18 September the corrected claim was emailed to claims@sisonkehealth.co.za. On 22 September a followup email was sent to info@sisonkehealth.co.za to find out if the resubmitted claim was received in order. No response has been received. Followups were done on 23 and 25 September without any response to date. Followup on Sisonkehealth Whatsapp was responded on 18 September to send claim to claims@sisonkehealth.co.za. The corrected claim was sent to claims@sisonkehealth.co.za on 18 September. On 23 September Sisonkehealth Whatsapp responded to foward the account to info@sisonkehealth.co.za. This was done on 23 September. On 25 September Sisonkehealth Whatsapp responded to say "we require the paper claim to info@medimed.co.za". The paper claim was sent to info@medimed.co.za on 25 September The doctors practice also notified me that the corrected claim keeps rejecting duplicate when they try to submit from their side. Sisonke Health, please advise if the corrected claim for 28 August from Dr R van Wyk has been received in order or not.
1 reviews | Active since Jan 2020
On 28 August 2025 a claim for Dr R van Wyk was rejected because it was submitted in duplicate. On 18 September the corrected claim was emailed to claims@sisonkehealth.co.za. On 22 September a followup email was sent to info@sisonkehealth.co.za to find out if the resubmitted claim was received in order. No response has been received. Followups were done on 23 and 25 September without any response to date. Followup on Sisonkehealth Whatsapp was responded on 18 September to send claim to claims@sisonkehealth.co.za. The corrected claim was sent to claims@sisonkehealth.co.za on 18 September. On 23 September Sisonkehealth Whatsapp responded to foward the account to info@sisonkehealth.co.za. This was done on 23 September. On 25 September Sisonkehealth Whatsapp responded to say "we require the paper claim to info@medimed.co.za". The paper claim was sent to info@medimed.co.za on 25 September The doctors practice also notified me that the corrected claim keeps rejecting duplicate when they try to submit from their side. Sisonke Health, please advise if the corrected claim for 28 August from Dr R van Wyk has been received in order or not.
1 reviews | Active since Jan 2020
Understood — thanks for clarifying 🙏. Since this is going to HelloPeter, the letter must be sharp, emotional, and crystal clear I am writing this because I can no longer stay silent about the way Sisonke Medical Aid Scheme has handled a deeply serious matter. My wife ,with a broken arm had to undergo an operation more than 3 years ago. The procedure was not done correctly, leaving parts of her arm still broken. Since then, she has been forced to live in constant pain, with her arm still not working properly. Instead of receiving proper help, she has been made to book appointment after appointment — only to be told repeatedly that “the medical aid does not want to sign.” when we at the hospital This raises a critical question: what kind of image does Sisonke Medical Aid want to present to the public if it cannot fulfill its most basic duty of giving members access to the funds they pay for? I the husband has been faithfully paying for medical aid, and yet, when my wife needed it most, she has been abandoned to suffer. Three years of waiting, three years of pain, three years without justice. This is unacceptable. Medical aid schemes exist to protect and support people during times of illness and injury. Sisonke’s handling of this case has shown the complete opposite — neglect, delay, and disregard for human Please Take urgent responsibility for this matter. If this is not resolved, the matter will be escalated to the Council for Medical Schemes . Sisonke Medical Aid must decide what kind of reputation it wants: one of integrity and care, or one of failure and neglect. Right now, it is failing its members. Chizane the husband😔😔 I wish the medical to contact me directly
1 reviews | Active since Jan 2020
Understood — thanks for clarifying 🙏. Since this is going to HelloPeter, the letter must be sharp, emotional, and crystal clear I am writing this because I can no longer stay silent about the way Sisonke Medical Aid Scheme has handled a deeply serious matter. My wife ,with a broken arm had to undergo an operation more than 3 years ago. The procedure was not done correctly, leaving parts of her arm still broken. Since then, she has been forced to live in constant pain, with her arm still not working properly. Instead of receiving proper help, she has been made to book appointment after appointment — only to be told repeatedly that “the medical aid does not want to sign.” when we at the hospital This raises a critical question: what kind of image does Sisonke Medical Aid want to present to the public if it cannot fulfill its most basic duty of giving members access to the funds they pay for? I the husband has been faithfully paying for medical aid, and yet, when my wife needed it most, she has been abandoned to suffer. Three years of waiting, three years of pain, three years without justice. This is unacceptable. Medical aid schemes exist to protect and support people during times of illness and injury. Sisonke’s handling of this case has shown the complete opposite — neglect, delay, and disregard for human Please Take urgent responsibility for this matter. If this is not resolved, the matter will be escalated to the Council for Medical Schemes . Sisonke Medical Aid must decide what kind of reputation it wants: one of integrity and care, or one of failure and neglect. Right now, it is failing its members. Chizane the husband😔😔 I wish the medical to contact me directly
1 reviews | Active since Jan 2020
Dr MK Mogwera needs to do a life saving heart valve replacement for Mr D Visagie. Sisonka is refusing payment of this procedure. How can you refuse to pay for a PMB procedure? You are referred to paragraph 8(2), (3), (4) of the Regulations to the Medical Schemes Act 131 of 1998. How will the CMS view your accreditation with your business practice of refusing to pay for essential healthcare services?
1 reviews | Active since Jan 2020
Dr MK Mogwera needs to do a life saving heart valve replacement for Mr D Visagie. Sisonka is refusing payment of this procedure. How can you refuse to pay for a PMB procedure? You are referred to paragraph 8(2), (3), (4) of the Regulations to the Medical Schemes Act 131 of 1998. How will the CMS view your accreditation with your business practice of refusing to pay for essential healthcare services?
1 reviews | Active since Jan 2020
Been on the phone for more than a hour getting trancferd from one department to the other with no compitant person willing to help or assist us just passing us along the department and then hang up the phone i dont know why i have to pay for a medical aid that cant even take a call how do thwy cover then
1 reviews | Active since Jan 2020
Been on the phone for more than a hour getting trancferd from one department to the other with no compitant person willing to help or assist us just passing us along the department and then hang up the phone i dont know why i have to pay for a medical aid that cant even take a call how do thwy cover then
1 reviews | Active since Jan 2020
Most useless medical aid ever, I requested my medical aid certificate for tax returns and waited 3 days with no assistance, this morning at 9am I called and spoke to a consultant and I’m still waiting even now. I can’t submit at SARS without that statement 😔😢
1 reviews | Active since Jan 2020
Most useless medical aid ever, I requested my medical aid certificate for tax returns and waited 3 days with no assistance, this morning at 9am I called and spoke to a consultant and I’m still waiting even now. I can’t submit at SARS without that statement 😔😢
1 reviews | Active since Jan 2020
All their doctors & nurses at the Rustenburg medical centre have zero professionalism. Dr's won't pay attention unless begged to do so otherwise they'll be busy on their cellphones. Your blood work is printed out & given to the receptionist to hand to the patient the doctors will broadcast at the reception what the nurses should assist you with while everyone is listening. By the time you leave that place even the cleaning lady will know exactly what you came there for. They don't respect patient confidentiality, it's like going to the government hospital. Especially that tall arrogant Dr who is always so condescending towards patients & disappears occasionally just to sit on his phone even during a consultation. Hire professionals for God's sake! I'm definitely changing my medical aid end of 2024 the fact that I'm paying 3800 for this ******* treatment is appalling
1 reviews | Active since Jan 2020
All their doctors & nurses at the Rustenburg medical centre have zero professionalism. Dr's won't pay attention unless begged to do so otherwise they'll be busy on their cellphones. Your blood work is printed out & given to the receptionist to hand to the patient the doctors will broadcast at the reception what the nurses should assist you with while everyone is listening. By the time you leave that place even the cleaning lady will know exactly what you came there for. They don't respect patient confidentiality, it's like going to the government hospital. Especially that tall arrogant Dr who is always so condescending towards patients & disappears occasionally just to sit on his phone even during a consultation. Hire professionals for God's sake! I'm definitely changing my medical aid end of 2024 the fact that I'm paying 3800 for this ******* treatment is appalling
1 reviews | Active since Jan 2020
On 11 December 2023, Dischem submitted a claim for medication prescribed by Oncologist, Dr F Michaelis for Ritha Ramsuchit (medical aid number P3387727 & ID number 660922 5150 087, ICD code 50.9)). The claim was submitted by Dischem online on the 11 December 2023. The script copy for the claim of 11 December 2023 is attached. On the 13 June 2024, I (Dhunraj Ramsuchit) was informed by Dischem that no payment was received from Sisonke Health for this treatment that was sent to Dr Michaelis oncology centre and so Dischem blocked the profile. This prevents Dischem from going into the profile to process another claim for the Stradexa tablets requested by Dr Michaelis on 04 June 2024 for Ritha Ramsuchit. I enquired from Dischem to clarify when and how the claim of 11 December 2023 was submitted to Sisonke Health. The response from Dischem is quoted as follows : “The date on the script copy that I sent through is the date the claim was processed. It dials through automatically as it is an online claim. We had a look and it showed that the claim went through on the oncology benefit and there was no levies due by member however, when our finance department went through all of the claim payments from the medical aid they noticed that there was no payment made from the medical aid for that claim. They also contacted the medical aid but did not receive any feedback as to why they never paid the claim.” The script copy was submitted by myself to Sisonke Health on 14 June 2024 to process together with my plea and context: “ps. The invoice was previously submitted online by Dischem but Dischem has not received payment as yet. The patient (my wife), Ritha Ramsuchit, is an oncology patient. She had a mastectomy of the left breast on 29 April. Her family has a long history of cancer where three of her siblings had passed-on from cancer. Dr Michaelis had prescribed further medication (Stradexa) for her treatment. Dischem is not in a position to process any further medication until outstanding amounts are settled. I am a pensioner and your urgent attention to this matter will be highly appreciated.” On 19 June 2024, Sisonke Health responded with the following: “Kindly be advised that the account for Dis-chem direct oncology dated 11/12/2023 has been received and will be submitted for processing in accordance with the Scheme Rules. Kindly note that the claim is older than 120 days and is now considered stale. Kindly forward proof of previous submission for the claim to be submitted for stale claim review.” This response from Sisonke Health was poor as the original submission was made by Dischem online on 11 December 2023 and further, the script copy was already provided to Sisonke Health by myself as well. I nevertheless again checked with Dischem on any further proof of submission. Dischem were taken aback by this request and again explained that the online claim should have been received by Sisonke Health on the same day, that is 11 December 2023. Sisonke Health would also have received other similar claims before and after 11 December 2023 from Dischem through this mechanism that were settled. I reverted to Sisonke Health on 20 June 2024 to please advise whether Sisonke Health received the online claim of 11 December 2023 from Dischem. I did not get an answer to my question. On 24 June 2024, I received a notification from Sisonke Health stating that “A claim for 2023/12/11 to the value of R 2495.55 from DIS-CHEM DIRECT ONCOLOGY PHARMACY for Ritha Ramsuchit has been received and processed. Ref: 2024-1884826” On 28 June 2024, I received a notification from Sisonke Health stating that “Kindly be advised that the proof of previous submission has been received and it will be submitted for stale claim review.” My question whether Sisonke Health received the online claim on 11 December 2023 from Dischem remained unanswered. On 28 June 2024, I received a further notification from Sisonke Health stating that “A claim for 2023/12/11 to the value of R 2495.55 from DIS-CHEM DIRECT ONCOLOGY PHARMACY for Ritha Ramsuchit has been received and processed. Ref: 2024-1922118” I checked with Dischem and Dischem did not receive any payment from Sisonke Health for the claim of 11 December 2023. On 03 July 2024, I received a notification from Sisonke Health stating that “Kindly be advised that the account for Mrs RITHA RAMSUCHIT SERVICE date 11/12/2023 has been received and will be resubmitted for reprocessing in accordance with the Scheme Rules.” This has left us frustrated especially considering that Sisonke Health processed the claim on 24 June 2024 (ref: 2024-188426) and processed the claim on 28 June 2024 (ref 2024-1922118) and on 03 July 2024 Sisonke Health will be resubmitting for reprocessing. On 03 July 2024, I made payment to Dischem for the 11 December 2023 claim. The patient (my wife), Ritha Ramsuchit, is an oncology patient. She last received oncology treatment medication on 25 March 2024. She had a mastectomy of the left breast on 29 April 2024. Her family has a long history of cancer where three of her siblings had passed-on from cancer. Dr Michaelis had prescribed further medication (Stradexa) for her treatment on 04 June 2024. Dischem is not in a position to process any further medication until outstanding amounts are settled. Waiting for Sisonke Health to reprocess the claim of 11 December 2023 is hurting and disrupting her oncology treatment. On 04 July 2024, I received a notification from Sisonke Health stating that “Kindly note the account for services rendered by Dis-Chem Direct Oncology Pharmacy on 11/12/2023 has been processed in accordance with the Scheme rules as the Stale claim has been approved and is awaiting a payment date.” On 04 July 2024, I received a statement from Sisonke Health stating that the claim from Dischem Direct Oncology for 11 December 2023 has been rejected because - “Claim received after valid claim period as specified in scheme rules.” My question whether Sisonke Health received the online claim of 11 December 2023 from Dischem remain unanswered. This claim should have been received by Sisonke Health at about the same time on the same day, 11 December 2023. It is vitally important to know what went wrong. My wife, Ritha Ramsuchit is expected to go on oncology treatment for the next ten years. During this time, we would be relying on the same system. If there is an issue, it needs to be identified so that processes can be put in place to prevent recurrence. Ritha Ramsuchit is dealing with the emotional and physical trauma of mastectomy that she had undergone on 29 April 2024. She has family history where three of her siblings passed away from cancer. The uncer*****y surrounding the processing of oncology treatment is agonising for us. The responses from Sisonke Health has been rigid, lacks empathy and resembles a robotic system. Typically saying “claim received and processed according to scheme rules.” While this is fine, it does not answer burning questions such as whether the online claim was received by Sisonke Health on 11 December 2023 or not. If the claim was not received by Sisonke Health on 11 December 2023, then what went wrong with the online system. If the claim was received by Sisonke Health on the 11 December 2023, then why was the claim not then processed in accordance with the scheme rules. Attempts to contact Sisonke Health via Whatsapp has not been fruitful. For example, on 03 July 2024 at 08h53 I requested to speak to an agent. I was given a ticket reference number #977019. I am still waiting for an agent. Sisonke Health your full and speedy response is awaited.
1 reviews | Active since Jan 2020
On 11 December 2023, Dischem submitted a claim for medication prescribed by Oncologist, Dr F Michaelis for Ritha Ramsuchit (medical aid number P3387727 & ID number 660922 5150 087, ICD code 50.9)). The claim was submitted by Dischem online on the 11 December 2023. The script copy for the claim of 11 December 2023 is attached. On the 13 June 2024, I (Dhunraj Ramsuchit) was informed by Dischem that no payment was received from Sisonke Health for this treatment that was sent to Dr Michaelis oncology centre and so Dischem blocked the profile. This prevents Dischem from going into the profile to process another claim for the Stradexa tablets requested by Dr Michaelis on 04 June 2024 for Ritha Ramsuchit. I enquired from Dischem to clarify when and how the claim of 11 December 2023 was submitted to Sisonke Health. The response from Dischem is quoted as follows : “The date on the script copy that I sent through is the date the claim was processed. It dials through automatically as it is an online claim. We had a look and it showed that the claim went through on the oncology benefit and there was no levies due by member however, when our finance department went through all of the claim payments from the medical aid they noticed that there was no payment made from the medical aid for that claim. They also contacted the medical aid but did not receive any feedback as to why they never paid the claim.” The script copy was submitted by myself to Sisonke Health on 14 June 2024 to process together with my plea and context: “ps. The invoice was previously submitted online by Dischem but Dischem has not received payment as yet. The patient (my wife), Ritha Ramsuchit, is an oncology patient. She had a mastectomy of the left breast on 29 April. Her family has a long history of cancer where three of her siblings had passed-on from cancer. Dr Michaelis had prescribed further medication (Stradexa) for her treatment. Dischem is not in a position to process any further medication until outstanding amounts are settled. I am a pensioner and your urgent attention to this matter will be highly appreciated.” On 19 June 2024, Sisonke Health responded with the following: “Kindly be advised that the account for Dis-chem direct oncology dated 11/12/2023 has been received and will be submitted for processing in accordance with the Scheme Rules. Kindly note that the claim is older than 120 days and is now considered stale. Kindly forward proof of previous submission for the claim to be submitted for stale claim review.” This response from Sisonke Health was poor as the original submission was made by Dischem online on 11 December 2023 and further, the script copy was already provided to Sisonke Health by myself as well. I nevertheless again checked with Dischem on any further proof of submission. Dischem were taken aback by this request and again explained that the online claim should have been received by Sisonke Health on the same day, that is 11 December 2023. Sisonke Health would also have received other similar claims before and after 11 December 2023 from Dischem through this mechanism that were settled. I reverted to Sisonke Health on 20 June 2024 to please advise whether Sisonke Health received the online claim of 11 December 2023 from Dischem. I did not get an answer to my question. On 24 June 2024, I received a notification from Sisonke Health stating that “A claim for 2023/12/11 to the value of R 2495.55 from DIS-CHEM DIRECT ONCOLOGY PHARMACY for Ritha Ramsuchit has been received and processed. Ref: 2024-1884826” On 28 June 2024, I received a notification from Sisonke Health stating that “Kindly be advised that the proof of previous submission has been received and it will be submitted for stale claim review.” My question whether Sisonke Health received the online claim on 11 December 2023 from Dischem remained unanswered. On 28 June 2024, I received a further notification from Sisonke Health stating that “A claim for 2023/12/11 to the value of R 2495.55 from DIS-CHEM DIRECT ONCOLOGY PHARMACY for Ritha Ramsuchit has been received and processed. Ref: 2024-1922118” I checked with Dischem and Dischem did not receive any payment from Sisonke Health for the claim of 11 December 2023. On 03 July 2024, I received a notification from Sisonke Health stating that “Kindly be advised that the account for Mrs RITHA RAMSUCHIT SERVICE date 11/12/2023 has been received and will be resubmitted for reprocessing in accordance with the Scheme Rules.” This has left us frustrated especially considering that Sisonke Health processed the claim on 24 June 2024 (ref: 2024-188426) and processed the claim on 28 June 2024 (ref 2024-1922118) and on 03 July 2024 Sisonke Health will be resubmitting for reprocessing. On 03 July 2024, I made payment to Dischem for the 11 December 2023 claim. The patient (my wife), Ritha Ramsuchit, is an oncology patient. She last received oncology treatment medication on 25 March 2024. She had a mastectomy of the left breast on 29 April 2024. Her family has a long history of cancer where three of her siblings had passed-on from cancer. Dr Michaelis had prescribed further medication (Stradexa) for her treatment on 04 June 2024. Dischem is not in a position to process any further medication until outstanding amounts are settled. Waiting for Sisonke Health to reprocess the claim of 11 December 2023 is hurting and disrupting her oncology treatment. On 04 July 2024, I received a notification from Sisonke Health stating that “Kindly note the account for services rendered by Dis-Chem Direct Oncology Pharmacy on 11/12/2023 has been processed in accordance with the Scheme rules as the Stale claim has been approved and is awaiting a payment date.” On 04 July 2024, I received a statement from Sisonke Health stating that the claim from Dischem Direct Oncology for 11 December 2023 has been rejected because - “Claim received after valid claim period as specified in scheme rules.” My question whether Sisonke Health received the online claim of 11 December 2023 from Dischem remain unanswered. This claim should have been received by Sisonke Health at about the same time on the same day, 11 December 2023. It is vitally important to know what went wrong. My wife, Ritha Ramsuchit is expected to go on oncology treatment for the next ten years. During this time, we would be relying on the same system. If there is an issue, it needs to be identified so that processes can be put in place to prevent recurrence. Ritha Ramsuchit is dealing with the emotional and physical trauma of mastectomy that she had undergone on 29 April 2024. She has family history where three of her siblings passed away from cancer. The uncer*****y surrounding the processing of oncology treatment is agonising for us. The responses from Sisonke Health has been rigid, lacks empathy and resembles a robotic system. Typically saying “claim received and processed according to scheme rules.” While this is fine, it does not answer burning questions such as whether the online claim was received by Sisonke Health on 11 December 2023 or not. If the claim was not received by Sisonke Health on 11 December 2023, then what went wrong with the online system. If the claim was received by Sisonke Health on the 11 December 2023, then why was the claim not then processed in accordance with the scheme rules. Attempts to contact Sisonke Health via Whatsapp has not been fruitful. For example, on 03 July 2024 at 08h53 I requested to speak to an agent. I was given a ticket reference number #977019. I am still waiting for an agent. Sisonke Health your full and speedy response is awaited.
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