HK
Henk K
1 reviews | Active since Mar 2009
05 May 2025, 17:01
AMBLEDOWN and MEDWAY are useless and must be avoided
Gross and digusting service from both AMBLEDOWN and their subsidiary MEDWAY Their emails and letter are totally non sensical and stupid. No cross reference and completely wrong medical condition quoted. Similarly MEDWAY claims office are absolutely clueless and do not responsibility. They keep on hiding behind PMB claims blaming the medical aid.
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Ambledown's replyOfficial
20 May 2025, 12:52Dear Henk,
Thank you for the review.
We regret the confusing experience.
We recognize the importance of clear communication and appreciate the opportunity to respond to the concerns raised regarding the submitted claims.
Thank you for the review.
We regret the confusing experience.
We recognize the importance of clear communication and appreciate the opportunity to respond to the concerns raised regarding the submitted claims.
Our records show that the ICD-10 code included in the claim documentation corresponds to a Prescribed Minimum Benefit (PMB) condition.
In accordance with the Medical Schemes Act No. 13 of 1998, all medical schemes in South Africa are legally obligated to cover the costs related to PMBs. These benefits encompass the diagnosis, treatment, and care of specified medical conditions and must be covered in full by the medical aid, without any co-payments or deductibles.
Our objective is not to inconvenience our members, but rather to ensure full compliance with the applicable legislation. By adhering to these requirements, we aim to prevent the inappropriate funding of costs that should be borne by the medical aid, thereby supporting the integrity of the healthcare system as outlined in the Demarcation Regulations.
To date, an amount of R8,124.06 was processed and paid to the Principal Member on 05 May 2025. At the time of your review, the claim relating to the specialist's services was under an independent review to determine its PMB status. This review has since been concluded, and the final outcome was communicated via email to the Principal Member on 14 May 2025.
We remain committed to addressing this matter transparently and efficiently and trust that the explanation provided clarifies the reason the claim was subject to a PMB assessment.
We encourage the Principal Member to consult with their broker for further guidance regarding product features, terms, and conditions.
Based on our review, it is our position that the claim has been fully assessed. Please feel free to contact us should you require any additional information or assistance.
Yours Sincerely
Paul Makwea
Compliance Department
Ambledown Financial Services (Pty) Ltd
Ambledown's reply20 May 2025, 12:52
Official
Dear Henk,
Thank you for the review.
We regret the confusing experience.
We recognize the importance of clear communication and appreciate the opportunity to respond to the concerns raised regarding the submitted claims.
Thank you for the review.
We regret the confusing experience.
We recognize the importance of clear communication and appreciate the opportunity to respond to the concerns raised regarding the submitted claims.
Our records show that the ICD-10 code included in the claim documentation corresponds to a Prescribed Minimum Benefit (PMB) condition.
In accordance with the Medical Schemes Act No. 13 of 1998, all medical schemes in South Africa are legally obligated to cover the costs related to PMBs. These benefits encompass the diagnosis, treatment, and care of specified medical conditions and must be covered in full by the medical aid, without any co-payments or deductibles.
Our objective is not to inconvenience our members, but rather to ensure full compliance with the applicable legislation. By adhering to these requirements, we aim to prevent the inappropriate funding of costs that should be borne by the medical aid, thereby supporting the integrity of the healthcare system as outlined in the Demarcation Regulations.
To date, an amount of R8,124.06 was processed and paid to the Principal Member on 05 May 2025. At the time of your review, the claim relating to the specialist's services was under an independent review to determine its PMB status. This review has since been concluded, and the final outcome was communicated via email to the Principal Member on 14 May 2025.
We remain committed to addressing this matter transparently and efficiently and trust that the explanation provided clarifies the reason the claim was subject to a PMB assessment.
We encourage the Principal Member to consult with their broker for further guidance regarding product features, terms, and conditions.
Based on our review, it is our position that the claim has been fully assessed. Please feel free to contact us should you require any additional information or assistance.
Yours Sincerely
Paul Makwea
Compliance Department
Ambledown Financial Services (Pty) Ltd