PD
Prunella D
1 reviews | Active since Jul 2022
15 Nov 2022, 10:06
Worst service and customer care
I am extremely dissatisfied with their services.I was hospitalized last year November all bills were settled by medical aid .This year August I was informed of a Dr bill that was over the rates.. I sent ambledown all the documentation and let them know we were informed late of said bill....They rejected the claim with no call from them to find out anything else i then sent it to compliance board and was also rejected .I am extremely frustrated as I have been with them about 7 years and made 2 claims with them .Now I have to pay a bill when it is of no fault of mine.Why do we take cover if they do not pay
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Ambledown's replyOfficial
28 Nov 2022, 20:49Dear Prunella D,
Thank you for your review above.
We regret that your claim was rejected. As stated in your email, it was submitted to Ambledown after the six months notification period.
The treatment date is recorded as 09 November 2021, Momentum processed payment of the claim for 01 December 2021 as per statement 8 of 2021, that we believe was sent to you dated 26 November 2021. From this record you should have known that the claim was not paid in full and immediately put in a gap claim.
Between the doctor's accounts department and yourself, we cannot comment on what transpired from December 2021 up until August 2022.
It remains your responsibility to submit the claim on time.
The liquidation of Constantia Insurance Company Limited (CICL) takes away Ambledown’ s ability to negotiate an ex-gratia settlement on your behalf. Ambledown does not have the mandate to review and decide on the claim for and on behalf of the liquidator of the estate. We suggest that you make an application to the liquidator using the following email address ***. Please note that you have limited time to do so, you can click on the link Constantia - Insurance made personal (constantiagroup.co.za) for more information.
Should there be anything additional that I can assist with, kindly send me an email at ***.
Thank you for your review above.
We regret that your claim was rejected. As stated in your email, it was submitted to Ambledown after the six months notification period.
The treatment date is recorded as 09 November 2021, Momentum processed payment of the claim for 01 December 2021 as per statement 8 of 2021, that we believe was sent to you dated 26 November 2021. From this record you should have known that the claim was not paid in full and immediately put in a gap claim.
Between the doctor's accounts department and yourself, we cannot comment on what transpired from December 2021 up until August 2022.
It remains your responsibility to submit the claim on time.
The liquidation of Constantia Insurance Company Limited (CICL) takes away Ambledown’ s ability to negotiate an ex-gratia settlement on your behalf. Ambledown does not have the mandate to review and decide on the claim for and on behalf of the liquidator of the estate. We suggest that you make an application to the liquidator using the following email address ***. Please note that you have limited time to do so, you can click on the link Constantia - Insurance made personal (constantiagroup.co.za) for more information.
Should there be anything additional that I can assist with, kindly send me an email at ***.
I thank you for your continued support, patience and understanding whilst I was attending to your query.
Yours Sincerely,
Yours Sincerely,
Paul Makwea | Risk and Compliance Department| Tel : ***| Switch Board : *** | ***
Ambledown's reply28 Nov 2022, 20:49
Official
Dear Prunella D,
Thank you for your review above.
We regret that your claim was rejected. As stated in your email, it was submitted to Ambledown after the six months notification period.
The treatment date is recorded as 09 November 2021, Momentum processed payment of the claim for 01 December 2021 as per statement 8 of 2021, that we believe was sent to you dated 26 November 2021. From this record you should have known that the claim was not paid in full and immediately put in a gap claim.
Between the doctor's accounts department and yourself, we cannot comment on what transpired from December 2021 up until August 2022.
It remains your responsibility to submit the claim on time.
The liquidation of Constantia Insurance Company Limited (CICL) takes away Ambledown’ s ability to negotiate an ex-gratia settlement on your behalf. Ambledown does not have the mandate to review and decide on the claim for and on behalf of the liquidator of the estate. We suggest that you make an application to the liquidator using the following email address ***. Please note that you have limited time to do so, you can click on the link Constantia - Insurance made personal (constantiagroup.co.za) for more information.
Should there be anything additional that I can assist with, kindly send me an email at ***.
Thank you for your review above.
We regret that your claim was rejected. As stated in your email, it was submitted to Ambledown after the six months notification period.
The treatment date is recorded as 09 November 2021, Momentum processed payment of the claim for 01 December 2021 as per statement 8 of 2021, that we believe was sent to you dated 26 November 2021. From this record you should have known that the claim was not paid in full and immediately put in a gap claim.
Between the doctor's accounts department and yourself, we cannot comment on what transpired from December 2021 up until August 2022.
It remains your responsibility to submit the claim on time.
The liquidation of Constantia Insurance Company Limited (CICL) takes away Ambledown’ s ability to negotiate an ex-gratia settlement on your behalf. Ambledown does not have the mandate to review and decide on the claim for and on behalf of the liquidator of the estate. We suggest that you make an application to the liquidator using the following email address ***. Please note that you have limited time to do so, you can click on the link Constantia - Insurance made personal (constantiagroup.co.za) for more information.
Should there be anything additional that I can assist with, kindly send me an email at ***.
I thank you for your continued support, patience and understanding whilst I was attending to your query.
Yours Sincerely,
Yours Sincerely,
Paul Makwea | Risk and Compliance Department| Tel : ***| Switch Board : *** | ***