DG
David G
1 reviews | Active since Feb 2018
17 Aug 2020, 14:26
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I submitted a claim for R3.817. After 3 weeks of excuses and after paying them for years I received a reply to say they are rejecting my claim because the hospital expenses are not covered. This is the very reason I took a gap cover from them is to cover the shortfall between what the medical aid doesn't cover. Please don't waste your time and money on this useless company because they will find any excuse to reject your claim.
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Ambledown's replyOfficial
17 Aug 2020, 15:35Dear David G,
Thank you for your review below.
The experience with your claim submission is regrettable and trust that your future interaction with us will be positive
You are correct the product does not cover hospital expenses, as per extraction below:
GENERAL EXCEPTIONS
Thank you for your review below.
The experience with your claim submission is regrettable and trust that your future interaction with us will be positive
You are correct the product does not cover hospital expenses, as per extraction below:
GENERAL EXCEPTIONS
The Company shall not be liable for hospitalisation, bodily injury, sickness or disease directly or indirectly caused by related to or in consequence of
No benefits are payable which should be provided by the medical aid scheme such as Prescribed Minimum Benefits.
No benefits are payable for ward fees, theatre fees, medicines, material expenses / costs and any other hospital expenses.
Any medical / surgical procedure not covered or declined by the medical aid scheme.”
Your understanding of the product findction is incorrect, "This is the very reason I took a gap cover". The product is not designed to cover ALL "the shortfall between what the medical aid doesn't cover."
I encourage you to engage with your broker to understand, the policy functions and benefits.
Yours Sincerely,
Paul Makwea
Risk and Compliance Department
***********
Ambledown's reply17 Aug 2020, 15:35
Official
Dear David G,
Thank you for your review below.
The experience with your claim submission is regrettable and trust that your future interaction with us will be positive
You are correct the product does not cover hospital expenses, as per extraction below:
GENERAL EXCEPTIONS
Thank you for your review below.
The experience with your claim submission is regrettable and trust that your future interaction with us will be positive
You are correct the product does not cover hospital expenses, as per extraction below:
GENERAL EXCEPTIONS
The Company shall not be liable for hospitalisation, bodily injury, sickness or disease directly or indirectly caused by related to or in consequence of
No benefits are payable which should be provided by the medical aid scheme such as Prescribed Minimum Benefits.
No benefits are payable for ward fees, theatre fees, medicines, material expenses / costs and any other hospital expenses.
Any medical / surgical procedure not covered or declined by the medical aid scheme.”
Your understanding of the product findction is incorrect, "This is the very reason I took a gap cover". The product is not designed to cover ALL "the shortfall between what the medical aid doesn't cover."
I encourage you to engage with your broker to understand, the policy functions and benefits.
Yours Sincerely,
Paul Makwea
Risk and Compliance Department
***********