1 reviews | Active since Mar 2020
Ambledown inconsistent and poor customer service
I have been with Ambledown for 14 years, usually claims arent an issue (the few times I have claimed)
I had a procedure done in the beginning of August - when the Dr called for Authorisation they received an email from Medical aid stating authorisation no. and stated in the same email that there was a co-payment due before the procedure is performed.
I paid the co-payment to the Dr and received an invoice and a receipt from the Dr. Upon submission of my claim to Ambledown, I included the following: Hospital Bill Drs Bill Letter from Medical aid with authorisation and notification of Co payment with exact amount Medical aid Statement (Not showing the copayment as a claim as it was paid upfront due to medical aid advising they were not going to cover it)
Then a few weeks later asking for a Revised Medical aid statement OR Revised Dr Account showing co payment! I sent revised Drs Account
Now nearly a month later I am being asked for a medical aid statement showing the co payment being claimed on the medical aid statement?????
How can I produce that now? The Drs account dept even confirmed with Ambledown that the co payment wasnt claimed due to medical notification that they will not be covering that amount.
Now I am being told that my claim is going to be rejected and not paid back unless the co payment isnt claimed for on a medical aid statement.
This is now Ridiculous!
I did a review on Facebook they asked for ref no. and my contact no. was told that I would be given feedback first thing yesterday morning from managament.
Here I am still waiting!!!!! FED UP
Thank you for your review above.
Reminder on the function of the product,.
Gap cover policy is designed to augment and not replace your medical aid scheme benefits.
Your gap cover claims assessment is dependent on the medical aid scheme assessment, hence the request for a detailed medical aid statement.
The policy defines co-payment as “Co-Payment” means a stated amount imposed as a co-payment or deductible by a medical scheme. A co-payment or deductible must be indicated in the rules of the medical scheme as approved by the Council for Medical Schemes.”
Though it may seem unnecessary , it is important that all amounts being claimed for, are submitted to the medical aid scheme. This is a regulation requirement, if not followed ,Ambledown will be deemed to be doing unregistered medical aid business.
I plead with you, that you work with us, and submit the full invoice(s) with all charges including those that you may have paid cash for, to Momentum.
On receipt of the revised Momentum assessment, we will process the reassessment on the co-payment and any other line items with a shortfall in line with your gap cover policy conditions.
Yours sincerely,
Paul Makwea
***
Thank you for your review above.
Reminder on the function of the product,.
Gap cover policy is designed to augment and not replace your medical aid scheme benefits.
Your gap cover claims assessment is dependent on the medical aid scheme assessment, hence the request for a detailed medical aid statement.
The policy defines co-payment as “Co-Payment” means a stated amount imposed as a co-payment or deductible by a medical scheme. A co-payment or deductible must be indicated in the rules of the medical scheme as approved by the Council for Medical Schemes.”
Though it may seem unnecessary , it is important that all amounts being claimed for, are submitted to the medical aid scheme. This is a regulation requirement, if not followed ,Ambledown will be deemed to be doing unregistered medical aid business.
I plead with you, that you work with us, and submit the full invoice(s) with all charges including those that you may have paid cash for, to Momentum.
On receipt of the revised Momentum assessment, we will process the reassessment on the co-payment and any other line items with a shortfall in line with your gap cover policy conditions.
Yours sincerely,
Paul Makwea
***
I have been working with ambledown submitting whaterver they have asked for in addition to what was originally submitted by myself.
Now I plead with you, can you please have one consistent way of doing claims and not one claims administrator request for either this OR that and the next administrator says BOTH!
Judging from my experience and other reviews, Ambledown has serious short comings that need to be addressed when it comes to customer service.
Its very upsetting to me that I had to go as far as Facebook reviews and Hello Peter reviews before I received a detailed explanation after waiting nearly a month.
I have been working with ambledown submitting whaterver they have asked for in addition to what was originally submitted by myself.
Now I plead with you, can you please have one consistent way of doing claims and not one claims administrator request for either this OR that and the next administrator says BOTH!
Judging from my experience and other reviews, Ambledown has serious short comings that need to be addressed when it comes to customer service.
Its very upsetting to me that I had to go as far as Facebook reviews and Hello Peter reviews before I received a detailed explanation after waiting nearly a month.
I was told I would be called back and am still waiting.
I was told I would be called back and am still waiting.