Appalling and shocking service.
My mom, whom is a pensioner (68 years of age) has been a policy holder with Amabledown since 2016. In October 2020, we upgraded her cover (with an increased premium). Since the "UPGRADE" of this policy have we had endless challenges when submitting claims. Not only are excuses made and given for rejection of claims, but also poor communication, follow up and customer service received. Today, 6 June, we have officially given them notice to terminate her policy and cover as we have found an alternative company for GAP COVER for my mom, and we remain appalled with the level of service received from Ambledown and the way they treat claims of LOYAL clients that has been paying premiums since 2016.
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Replies (2)
Ambledown's replyOfficial
06 Jun 2023, 12:49Dear Mr Andre B Van Wyk,
Thank you for the review.
We regret the experience as shared.
I summarise the response to that, it is our interpretation that the claims were assessed as per policy terms and conditions.
Detailed feedback will be given for each claim on email. Cubix will follow up with a phone call. The policy is not designed to pay for all forms of costs that are not covered by the medical aid scheme nor replace a medical aid scheme by covering costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms.
The policy defines the "Defined Events" as:
DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in the policy document. So there must be hospital confinement, which was not the case with some of the recent claims that I looked at. I will provide detailed for each assessment on email. I regret that you have decided to use another gap cover provider, however we respect your decision and will ensure that the cancellation is processed without hindrance.
We trust that our product will interest you again in future.
Yours sincerely
Paul Makwea
***
Thank you for the review.
We regret the experience as shared.
I summarise the response to that, it is our interpretation that the claims were assessed as per policy terms and conditions.
Detailed feedback will be given for each claim on email. Cubix will follow up with a phone call. The policy is not designed to pay for all forms of costs that are not covered by the medical aid scheme nor replace a medical aid scheme by covering costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms.
The policy defines the "Defined Events" as:
DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in the policy document. So there must be hospital confinement, which was not the case with some of the recent claims that I looked at. I will provide detailed for each assessment on email. I regret that you have decided to use another gap cover provider, however we respect your decision and will ensure that the cancellation is processed without hindrance.
We trust that our product will interest you again in future.
Yours sincerely
Paul Makwea
***
Best regards,
Ambledown's reply06 Jun 2023, 12:49
Official
Dear Mr Andre B Van Wyk,
Thank you for the review.
We regret the experience as shared.
I summarise the response to that, it is our interpretation that the claims were assessed as per policy terms and conditions.
Detailed feedback will be given for each claim on email. Cubix will follow up with a phone call. The policy is not designed to pay for all forms of costs that are not covered by the medical aid scheme nor replace a medical aid scheme by covering costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms.
The policy defines the "Defined Events" as:
DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in the policy document. So there must be hospital confinement, which was not the case with some of the recent claims that I looked at. I will provide detailed for each assessment on email. I regret that you have decided to use another gap cover provider, however we respect your decision and will ensure that the cancellation is processed without hindrance.
We trust that our product will interest you again in future.
Yours sincerely
Paul Makwea
***
Thank you for the review.
We regret the experience as shared.
I summarise the response to that, it is our interpretation that the claims were assessed as per policy terms and conditions.
Detailed feedback will be given for each claim on email. Cubix will follow up with a phone call. The policy is not designed to pay for all forms of costs that are not covered by the medical aid scheme nor replace a medical aid scheme by covering costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms.
The policy defines the "Defined Events" as:
DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in the policy document. So there must be hospital confinement, which was not the case with some of the recent claims that I looked at. I will provide detailed for each assessment on email. I regret that you have decided to use another gap cover provider, however we respect your decision and will ensure that the cancellation is processed without hindrance.
We trust that our product will interest you again in future.
Yours sincerely
Paul Makwea
***
Best regards,
's updateReviewer Update
06 Jun 2023, 12:58Good afternoon
Another excuse. And that on a PUBLIC platform!!!!! Please refer to the rejected LANCET LABORATORIES claims submitted for services rendered during HOSPITALISATION from 17 - 30 March 2023. Then you will see that your copy / paste response above MAKES NO SENSE!
Another excuse. And that on a PUBLIC platform!!!!! Please refer to the rejected LANCET LABORATORIES claims submitted for services rendered during HOSPITALISATION from 17 - 30 March 2023. Then you will see that your copy / paste response above MAKES NO SENSE!
's update06 Jun 2023, 12:58
Reviewer Update
Good afternoon
Another excuse. And that on a PUBLIC platform!!!!! Please refer to the rejected LANCET LABORATORIES claims submitted for services rendered during HOSPITALISATION from 17 - 30 March 2023. Then you will see that your copy / paste response above MAKES NO SENSE!
Another excuse. And that on a PUBLIC platform!!!!! Please refer to the rejected LANCET LABORATORIES claims submitted for services rendered during HOSPITALISATION from 17 - 30 March 2023. Then you will see that your copy / paste response above MAKES NO SENSE!