Wooltru is not in the business of honoring claims

Momentum/ Wooltru is a true definition of pure capitalist, and in the business of not paying claims. We contacted the medical aid regarding getting braces for my 12 year old daughter who needs braces not for cosmetic but as a need as a child with bad dentals, On contacting them advised that we would need to get authorization for this, this by means of the dentist giving them some sort of motivation, the Dr wrote an entire thesaurus of motivation as well as a quote was sent. They then approved the fitting of the braces and gave us a break down of what would be paid by them at medical aid rates, which was 19000 and a couple of rands from a quote of 30000, the shortfall of 10 thousand would fall on us. The braces were fitted in August and we paid our part of the invoice. The Dr claimed for consultation as well and the fitment of braces. No payment was done, on our second visit the Dr advised he was never paid. On calling Momentum they advises the claims were not received, but proof from the Dr was sent to us, they then advised that the claim was sent to the incorrect email and couldn't be routed to the correct one, they advised that they would attend to it, but I had to call two more times just for the invoice on the 12th and 17th of Sept without having received a resolve to the issue, half the time when I called nobody seemed to even know what was happening with the claim call ref:698482596, I still had to send an email for the follow up after they has promised that they would make payment. On the 29th of Sept Dr sent me an email to advise payment was made however it there was a shortfall of R1580.05, which I had to make an arrangement to pay the Dr. September payment was rejected, citing incorrect codes were used, the Dr resubmitted and when we went for monthly visit again we were told that the claims for October were also not honored, this after the medical "scheme" sent us a nice letter advising of what would be paid by them, but now the entire account is now the responsibility of the member. on the 24th of Nov they were contacted and by email on the 24th and they responded on the 27th advising that the Dr must resubmit the claims under the correct email address, which baffles me is the company cannot reroute emails to the correct department for payment, and members and services providers have to constantly call to follow up and on these claims and we are taking from pillar to post. 26th Nov member called again ref: 709158486 and was told Dr needs to resubmit, which he did, 27th Nov ref: 708744767 an email was sent advising they called the Dr and advised the DOS 10/10/2025 and 08/11/2025 tariff 8890 was rejected as the claim do not refect on the dental system, on the same day this was sent it was forwarded to to the Dr because he knew that he has sent these claims, the Dr took it upon himself to call the medical aid and to his surprise he was not told what was said on the email but that the medical aid funds were depleted, call with Jerusha ref: 709316186,this message was relayed to us and we contacted the medical aid to get an understanding of how the story keeps changing, We were told by a Juliet that medical aid fund were depleted and therefore everything is now for the member's account. On asking to speak to the teamleader or manager of the contact centre we were told that they leave at at 16:00 when the call centre closes at 16:30 and I asked, who then takes escalation calls in this instance and she relayed that it is the consultants. I then proceeded to asked about the sudden funds are depleted statement, to which I was told that I should have read what they said on the letter where they advised that they would be paying the 19k that this is subject to the savings and I as the member should have read that and it was my responsibility to make sure that there are enough funds for this procedure, I then asked was it not the medical aids responsibility to advise the member on what is left in the funds when drafting the letter which is misleading in wording advising they are going to be paying 19k, only for them to take us from pillar to post and only at the end to say sorry, we will not be paying this, you should have read and now you are paying for this, there was no accountability whatsoever taking by momentum, only a blame game when a child is in need of braces and the member is paying the medical every month without fail. This in my opinion would have never happened to a white dentist and client, medical aids just what to milk capitalist company like momentum are only too happy to receive funds from black people and give them appaling services, while racially profiling black doctors who work hard to provide services to their patients, but everytime a claim comes, the scheme will do anything and everything possible not to pay them. We as patients are left with bills and yet without fail premiums are paid. This standard of service is totally disgusting to say the least, responsibility always fall of the patients but never on the company's because they have clauses that fill up books that they hide behind, while the CEOS of these companies are getting fat cheques and bonus. In my conversation with the agent, I requested that the TL call me to discuss this on the 28th of Nov, and they decided that my grievance is not important enough for them to give me call as I had waited the until 17:40 in the evening and nothing no call was received. and that is how members are treated at wooltru momentum.