Essential Med Complaint
 SUPPLIER |
Essential Med |
 INDUSTRY |
Insurance |
| BRANCH / AREA | Johannesburg | COUNTRY | South Africa |
| TIME / DATE | 21:35 Sun 31 Jul | PERSON RESPONSIBLE | |
| CUSTOMER | wtorr | View all reports by user |
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3
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| PROBLEM | Billing / Accounts |
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| INCIDENT | Sun 31 Jul | ||
| HEADLINE | Essential Med does not pay claims! |
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When I went with Essential Med I had to change my dentists to one on their list. I did that went to the dentist & got a quote for work that needed to be done. Their would not approve it. I got the dentist to sort it out with them as it was what their website says they cover. I got a call & the dentists told me that it has now been approved. I had a follow up appointment with the dentist. I have submitted the bills from the dentists to Essential Med & they refuse to pay. I have cancelled with them & they asked why I cancelled so I gave them the reason again & sent the outstanding statement to them. They did not reply. I feel the only way is to take legal action against such companies. |
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| SUPPLIER'S RESPONSE | Essential Med | Time and Date | 14:48:43 | Tue 23 Aug 11 |
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Hello wtorr, Thank you for bringing this matter to our attention. We have investigated it and can reply as follows: Two dental claims were submitted, one for R 666-00 for 3 March 2011 and the other for R 507-50 for 31 May 2011. We regret that we were only able to pay out part of these claims as a result of some of the service codes being for services not covered under our stated policy benefits. Our contracted Care Cross service providers are aware of our schedule of benefits and have a desk reference of the benefits covered under our policy. The payment of services is subject to each being within the scope of the formulary. We regret that your dentist did not advise you that some of the services to be provided were not within the scope of the policy benefits and would need to be paid by you. We encourage our clients at all times to check with medical practitioners whether all services to be provided are in fact covered under our policy benefits, which have been designed to cover a wide range of essential medical procedures. For more information on the codes not paid, please contact our client services department. Kind regards Lee Rodgers Operations manager |
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| CUSTOMER'S FEEDBACK | wtorr | Time and Date | 08:59:40 | Tue 31 Jan 12 |
| Utterly Disgusted: They approved it & still did not pay, so reading their reply they are not honest! | |||
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