Clientele Premium Hospital Bogus Cover- How I was cheated and bul**** by Clientele, my health is now at Risk

<p>I have been a Loyal paying premium member of Clientele for the past 7 years, my premiums are always collected without fail. In the 7 years I had 2 small claims this current one being the 3rd one. On the 27th of every month a whooping R568.50 with an annual increase of 10% is being collected from my account without any fail.<br />One would think that with such an awesome track record, one wouldn’t have to experience such drama at claim stage. I had a medical emergency on the 7th of Feb and rushed to a hospital where they picked up that my condition is rather critical, I was then transferred to the ICU Heart Hospital Pretoria, from the 10th to the 13th of February. When I submitted the claim, I had included all the required documents requested, including the hospital invoice. When they eventually paid the claim but they paid it minus the ICU benefit. When I call them, I spoke to Tiro Moremi , who placed me on hold to confirm his response with his manager/supervisor first called they told me that I should get proof from the hospital (the hospital invoice must quote “ICU” “ or the doctor must quote that I was admitted in ICU. I called the Hospital they informed me their invoices are universal for all their patients who have been admitted in ICU, they don’t quote the word “ICU” but the IC10 code and the amount claimed, confirmed that this was an ICU admission. My doctor sent an official medical certificate stating that I was admitted in ICU. I called back & spoke to Tshepo/Tshepa Moerane, who gave me feedback that Clientele is not accepting the doctor (who is a commissioner of oath)’s document, and that they are not going to pay. I asked to speak to the manager and I was connected to Helena van der Watt on the 7th April 2017 at 02:40, who abruptly told me that there is nothing they can do. I then asked her why they haven’t appointed an assessor to investigate and verify my claim, as I have exhausted my resources. She said she will speak to her manager; she called the next day & told me they are not covering my claim if the word “ICU” is not reflecting on the invoice. I was so livid, and disappointed that my loyalty for all these years meant nothing and that I am losing a claim only because of a word “ICU” which was not in my control to change. We join these policies to have peace of mind when we are not well so that we can enjoy our healing process, but I am afraid to say that, this was not my experience with Clientele. Instead they have managed to get me so worked up that I might end being admitted at the Heart Hospital again. Is it right that I’m not getting cover just because of a small technicality which they could have just easily resolved by appointing an assessor, or picking up the phone to confirm?</p>