JQ
John Q
1 reviews | Active since Aug 2021
27 Sept 2022, 21:34
Awaiting voice clip where waiver on co payment was declined.
Submitted a claim being stalled for months. Now advised co payment was wavered at point of sale.
Now 4 days later after being pushed from pille to post got in contact with talksure as these con artists are only the administrators of this product. Four days later still awaiting for voice clip and when I call Amanda is always on lunch called @ 10 am she was on lunch and at 16.30 still on lunch. ?
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Ambledown's replyOfficial
18 Oct 2022, 12:27Dear John Q,
Thank you for the feedback on the claim assessment below.
The shortfall relates to a co-payment, imposed by your medical aid.
Regrettably you do not have the co-payment benefit on your policy.
Regrettably you do not have the co-payment benefit on your policy.
“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.”
The general exception below was app**** in the assessment of your claim:
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
- Co-Payment.
It is our interpretation that the claim was assessed correctly.
I regret that we cannot reverse the decision on the previous claim but trust that you will find the above explanation to be in order.
I encourage you to contact the Talksure (now Cubix Solutions) Client Services Team for further clarification regarding the benefits and policy terms and conditions on ***Monday to Friday between 08h00 to 17h00. They will also assist you with policy benefit upgrade should you be interested.
Should there be anything additional that I can assist with, kindly send me an email on ***.
I thank you for your continued support, patience and understanding whilst I was attending to your query.
Yours Sincerely
Paul Makwea
***
Ambledown's reply18 Oct 2022, 12:27
Official
Dear John Q,
Thank you for the feedback on the claim assessment below.
The shortfall relates to a co-payment, imposed by your medical aid.
Regrettably you do not have the co-payment benefit on your policy.
Regrettably you do not have the co-payment benefit on your policy.
“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.”
The general exception below was app**** in the assessment of your claim:
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
- Co-Payment.
It is our interpretation that the claim was assessed correctly.
I regret that we cannot reverse the decision on the previous claim but trust that you will find the above explanation to be in order.
I encourage you to contact the Talksure (now Cubix Solutions) Client Services Team for further clarification regarding the benefits and policy terms and conditions on ***Monday to Friday between 08h00 to 17h00. They will also assist you with policy benefit upgrade should you be interested.
Should there be anything additional that I can assist with, kindly send me an email on ***.
I thank you for your continued support, patience and understanding whilst I was attending to your query.
Yours Sincerely
Paul Makwea
***