Ambledown - RUN!!!! CONTRADICTING POLICIES AND IMCOMPETENT STAFF.

AMBLEDOWN FINANCIAL SERVICES UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED (CICL)

I was scheduled for a C-Section on the 26th of January 2021, where we had to pay a penalty co-payment for the anesthesiologist. OUR COVER IS GAP PLUS LEVEL 4.

January 14th AND February 25th - we sent emails to ask Ambledown how the claim process works, what docs to send through, etc.

March 30th - We sent through our documentation and claim form WITHOUT receiving confirmation from Ambledown. We only received confirmation of receipt/document request TWO DAYS LATER, on April 1st.

April 1st - Document request and claim receipt confirmation. Which we stated that everything has been sent already on March 30th. NOTE THAT THE RESPONSE STATED THAT WE WILL RECEIVE FEEDBACK IN 10 WORKING DAYS.

April 13th to April 16th 13th - According to our mail sent on the 30th, our claim has passed 10 working days already. So, we followed up, no response. 14th - Followed up again, no response. 15th - Followed up again, no response. 16th - Followed up again, even phoned. According to the consultant, our claim has been escalated for finalization.

April 19th AND April 20th - MORE THAN 15 WORKING DAYS ALREADY 19th - Followed up again, no response. 20th - Followed up again. The claim has been escalated again, according to the consultant. LATER the afternoon we received a response that our claim has been rejected due to SPLIT BILLING (ACCORDING TO HPCSA, SPLIT BILLING IS ********* AND *******!!). We phoned Ambledown again to ask if they would be willing to accept rectified docs, and they agreed.

We then sought advice from Discovery and the anesthesiologist, where both of them were more than willing to help and send us rectified documents. After a long battle fixing everything, we sent in our rectified documents on June 30th.

June 30th - Rectified documents sent and confirmation received from Ambledown.

July 6th - Received feedback that our claim once again got rejected!!! Consultant's response: "This is co-payment on a service provider that was imposed as you are not on the plan type covered by a doctor. It is a penalty co-payment that is not covered by Gap. The anesthetist penalized you for not being on a classic plan therefore the R1000. The term co-payment is used to describe the member portion due but is in fact in this case a penalty. Please refer to your Discovery brochure and note the co-payments that are imposed on procedures which Gap will definitely cover as the reason codes will reflect as such on the Discovery statement."

We took everything up with Discovery and the anesthesiologist again, where both parties got involved by sending the claim to Ambledown's compliance department and getting confirmation from a consultant that our gap cover plan INDEED DOES COVER A PENALTY CO-PAYMENT.

July 8th - we escalated the matter to the Compliance Department. No confirmation was received.

July 9th - Followed up for confirmation, and we were told that the process could take 14 WORKING DAYS.

July 15th - Followed up for progress, no response.

July 28th - Followed up, no response and now here we are on Hello Peter. Next up are HPCSA and Ombuds.

Every single time there seems to be a different excuse for rejecting the claim. I also read a lot of concerning reviews, this place should be closed down!!!!!!