UNFAIRNESS, POOR MANAGEMENT OF CLAIMS

I would like to share my story with regards to AIG hospital plan. I was admitted in hospital on the 10 November 2019 and discharged on the 15 November 2019, the doctor booked me offsick and only came back to work on the 27 November 2019. On the 27 November 2019 I than contacted AIG and I spoke to Mr Amandla Sibiya who took down my claim and said he will refer me to my examiner details are as follows: Sanukapriya Rajagopal, ***, ***I than email my documents which are hospital account, ID, Bank Statement, X-RAYS at the back of my mind I knew that 1 or 2 documents are still pending like a medical report from my doctor. To my surprise on the 28 November 2019 @ 09:07am I received an email from the examiner saying my claim is out of scope to be addressed as an express claim, I that email back to the examiner asking to be more detailed because I did not understand what he was referring to. I feel this examiner did not treat my claim with respect and dignity, there is absolutely no customer care , I was still expecting him to call or email me informing me if all my documents were correctly submitted or either way but no. I would like to know steps the examiner followed when he examined my claim as an examiner, I would like my claim to be referred to someone else who will treat people's claim with some sort of respect and fairness. Mind you this is not the first claim being turned down like this without any explanation if I am not mistaken I sent a claim in July this year and was unsuccessful and when I asked for reasons no one cared to come back to me. Why is AIG examiners act as if we like being sick and admitted to hospitals we do not book ourself in hospitals, we do not ask to be ill and only the doctor has powers to admit a patient for further management. AIG needs to workshop and talk to your examiners on how to handle claims because I feel I am being targeted because this is not the first time treated like this. AIG I have been loyal to you all these years because I trusted you that is why I am still with you till date I never missed a premium . What is really happening am I being targeted because of my gender or race I will not stop at this level regarding this unfair treatment. please note that as we are your clients we also have got some background of how insurance companies operate so please kindly correct what need to be corrected. your examiner is contradicting with your hospital plan guidelines we read them they are published on internet. I was told this policy covers me if I am hospitalized and not more than 180 day per annum. What you get if you take out the AIG Health Cash Plan: • While you are in hospital you will be paid out R2 500 a day – all this for only R85.00 a day. • You will have cover for hospitalisation due to illness or accidents. • If you are in intensive care, there are double benefits and you will then be paid out R5 000 a day. • Maternity benefits are included. • The nice thing about this cover is that you are not asked any awkward medical questions. • Cover kicks in from the very first day you are admitted. • The benefit pays up to 180 days in hospital. • This cover is not only available to you but for your entire family as well. • Note that the insurance cover is available to persons from the ages of 18 to 65 years of age. • A small admin fee is payable. As is the case with many insurance products, there are certain exclusions which include: • HIV/AIDS plus any infections affiliated with HIV/AIDS. • Convalescent home. • Hospices, frail-care centres or other places where confinement takes place. • Any pre-existing conditions for the first 24 months of the condition. • Maternity during the first year. • Miscarriage or ******** or complications from childbirth. • Illness claims for the first 90 days are excluded. • Diabetes, epilepsy and any mental conditions are all excluded. I repeat please revive, workshop, train your examiners we need to be treated fairly with dignity as well. I think the examiner allocated to me does not have time did not consider me, he followed a trend on how my claims are being treated at AIG, I feel im being targeted my be it because of my race I don't know. I would appreciate an urgent response I am currently using this number *** and my email. Please stop this tendency it is not good I am angry and disgusted at the same time. thank you