Essential Med Complaint
 SUPPLIER |
Essential Med |
 INDUSTRY |
Insurance |
| BRANCH / AREA | Cape Town | COUNTRY | South Africa |
| TIME / DATE | 11:11 Tue 7 Feb | PERSON RESPONSIBLE | Nicolene |
| CUSTOMER | Riyaad24 | View all reports by user |
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| PROBLEM | Billing / Accounts |
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| INCIDENT | Tue 7 Feb | ||
| HEADLINE | My accounts has not been paid for almost a year |
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I was in a motor vehicle accident in April 2011 and i was told that Essential Med covers injuries to the value of R120 000, i received confirmation from Nicolene that i could go for physio and the physio then referred me to a specialist as my injuries was not getting any better, i was then referred to have a MRI that Nicolene confirmed with the provider that they can go ahead there is enough funds available. After numerous emails to Nicolene and calls to Elise saying that they will get back to me which never happens, I've been getting lawyers letters from the providers for outstanding payments that Essential Med never maid. Elise confirmed with me that the hospital bill was paid and they now after almost a year need motivation letters from these providers stating why i had to get the treatment?? I was requested to get these letters from them and i refused to do that as i literally had to dodge them because of Essential Med not making payment. If you guys are not going to make payment of the accounts that was sent to me, i will take this up with the ombudsman as well as cancel my policy and badmouth you guys to everyone i know. This is a promise. Yours in Anger Riyaad |
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| SUPPLIER'S RESPONSE | Essential Med | Time and Date | 16:57:59 | Tue 7 Feb 12 |
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Hello Riyaad24, On investigation, our records indicate payment of all accounts and claims received even though we received the necessary paperwork well after the 3-month submission period stated in our policy rules. The only accounts still payable are those for radiology which, as indicated in our communication to you, will be paid this Friday. With regard to the accounts submitted for physiotherapy, the diagnostic / treatment codes reflected do not relate to your accident injuries and payment was thus declined. For us to re-evaluate your claims, we require written motivations from the specialists involved, indicating why these seemingly 'unrelated' treatments were necessary. As stated in your complaint, you have thus far refused - despite several requests - to ask the specialists concerned to submit the necessary motivations and this has made it impossible for us to re-evaluate these particular claims. In our continued effort to assist you, one of our consultants will be in touch with you shortly to discuss these particular accounts. Your continued good health is important to us - please assist us to assist you in this matter. Kind regards Lee Rodgers Chief Operating Officer |
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