BM
Bernita M

1 reviews | Active since Feb 2017

15 Feb 2017, 18:06

Clientele says my husbands near death experience was only worth a 5 day payout after 13 days in hospital

<p>My husband and i left for our year end trip to Cape Town on the 22nd December. Prior to our depature he was already feeling ill and he saw our local doctor twice, he was diagnised with scarlet fever and was told he would recover in a few days. On the way down he fell very ill and he had to be admitted to hospital in East London.</p> <p>A planned one night stay in East London turned into a 13 day long nightmare. He had Steven Johnson Syndrome. A rare life threatning illness which he is still recovering from today. I filed a claim with clientele-hospital plan becasue he could not talk or walk at the time, 7 hours away from home i was sure to ask the consultants to stipulate all the relevant documentation that would be required, because i knew that once we got home we could not go back. I submitted the claim on the 11 January 2017 and after numerous calls to Clientelle my husband was finally paid out for 5 days yesterday the 14 February.</p> <p>I made yet another call to enquire how they had arrived at the amount he had been paid to which Clientelle's response was that his illness was only worth a 5 day stay in hospital. </p> <p>Firstly, SJS is so rare that it took days to diagnose. There is no test to diagnose it and absolutely no treatment. So Dr Clientele, please explain how with facial swelling, Tongue swelling, Hives, Skin pain, joint pain, A skin rash that spreads within hours, Blisters on your skin and the mucous membranes of your mouth, nose, eyes and *******s as well as shedding of your skin. Please tell me how you justify saying that a 5 day hospitalisation is sufficient? And now you expect me to return to East London from KZN for the clinic file from the hospital? After I asked you what was needed for the claim! Communication has been so poor , I have done all the calling regarding this claim. Up until today he is still suffering the repercussions of this illness, his nails are now falling off.</p> <p>We will certainly be cancelling this policy once or if this issue is ever resolved, at first they couldn't read the doctuments they asked for in the first place and now they want a clinic file.</p> <p>Pathetic service!</p>

0
Replies (2)
Clientele Life
Clientele Life's reply16 Feb 2017, 07:10
Official

Thank you for raising your concerns with us.

Your query has been escalated to the relevant department for investigation and we will be in contact to assist you further with the matter.

Yours sincerely,

Benita Steyn

Service Recovery Specialist

Clientele Life
Clientele Life's reply16 Feb 2017, 08:12
Official

Thank you for raising your concerns and bringing this matter to our attention.

At the outset we would like to apologise for any delays you might have experienced in the assessment of your claim. This is not the level of service we aim to provide our clients and we assure you of our best intentions.

We confirm that our Claims Assessor (Xoli Hadebe) was in contact with you regarding this claim, and confirmed the outstanding documents needed in order review your claim.

Based on pathological clinical evidence and discharge summary submitted for the diagnosis made and treatment thereof, Length of stay in hospital is clinically justified for five days for management and treatment of the condition that Mr GS Morkel was admitted and treated for.

The remaining LOS, as it was explained to you, will be reviewed once complete clinic file is submitted to conclusively determine the clinical indication for extended LOS (length of stay)

Should you require any further assistance in this regard please feel free to contact us again.

Kind Regards
Claims Department