Essential Med Complaint
 SUPPLIER |
Essential Med |
 INDUSTRY |
Insurance |
| BRANCH / AREA | Head Office | COUNTRY | South Africa |
| TIME / DATE | 13:31 Thu 25 Aug | PERSON RESPONSIBLE | Director |
| CUSTOMER | jumari21 | View all reports by user |
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| PROBLEM | Billing / Accounts |
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| INCIDENT | Thu 25 Aug | ||
| HEADLINE | Medical Aid Authorises Procedure and NOW wont pay |
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| Mrs Maritza Smit went to Midmed Hospital for a procedure authorised by Essential Med, Now they claim that the information supplied when i applied for membership was not true and correct and that i falselly gave information thru - did they in fact check my original application form ? - i found a fault on their application form after they denied paying the Hospital and other service providers - they also Blatantly refused to pay back my installment i paid over an 16 month period ! - this is blatant ***** | |||
| SUPPLIER'S RESPONSE | Essential Med | Time and Date | 16:37:05 | Thu 15 Sep 11 |
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Hello jumari21, We have already replied to this complaint on this public platform. As indicated previously, our application form includes a section on medical history where you are required to disclose medical conditions or procedures that you have undergone, some of which may be classified as pre-existing conditions - this is standard practice in the medical industry. Unfortunately, as you failed to disclose a previous operation for the same condition, this is deemed to be a pre-existing condition and you are not entitled to any benefits under that condition. Your claim was thus repudiated. One of our Claims Department personnel will be in contact with your shortly to provide you with a report from the relevant medical practitioner confirming the above. Kind regards Lee Rodgers Operations manager |
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| CUSTOMER'S FEEDBACK | jumari21 | Time and Date | 07:20:45 | Tue 27 Mar 12 |
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Utterly Disgusted:
Lee Rodgers, You dont even have a clue that the Original MAIN MEMBER had NO pre existing conditions - the Authorization was given for an operation to a member and NOT the MAin Member. WE ARE PROCEEDING WITH LEGAL ACTION AGAINST ESSENTIAL MED and we ensure that every stop and obstacle will be removed to ensure ESSENTIAL MED's compliance - you tickled the feathers of the wrong bird |
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