SAMWU National Medical Scheme
Not paying for my bills saying it is too much

Im pearl masendi since i joined samwumed medical scheme from 2008. On 2012 I was supposed to do eye operation and when I called the call center they said that Ive been given authorization but i couldn't go because the octave lance where not yer there at the hospital, then i called and told them that i will give them the correct date but when i got back to the call center they tell me that the motivation form the doctor doesn't have enough information like the no that the eye can see Ive send the no and it was okay, but they ended up not giving authorization i went and paid the money on Friday because Monday i was supposed to be at theater. When im claiming my money they say that they cant pay me because of Exclusion Rule 2.6 on page 34 of the member guide whereas when you join they didn't tell me about those rules and again i took the matter to their agents who told me that the scheme says the operation was too expensive that is why it was not paid, I even took the matter to the ombudsman since April 2013 there is no reply they keep on saying they will get back to me please help me i need my money back

Company: SAMWU National Medical Scheme
Country: South Africa
City: Capetown

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