1 reviews | Active since May 2016
ONCE AGAIN, PATHETIC SERVICE FROM CLIENTELE LIFE
My positive ratings for Clientele go out the door because their negative reviews weigh more than the positive. I have a hospital plan with them. The normal procedure is when you are hospitalized, you submit a claim and when the claim is approved and paid, the assessor calls you to advise how much they paid, how they paid and where they paid the claim from ( in cases on chronic ). According to the policy we have 15 days chronic benefit. I was in hospital January 2019 for 6 days. This claim was paid from my chronic benefit. I agreed and was happy. I was then admitted in March 2019, for SEPTICEMIA ( 16 DAYS ). This claim was paid accordingly. BUT ITS COMMON SENSE THAT THIS IS NOT A CHRONIC CONDITION AND THE ASSESSOR NEVER CALLED ME. I did not worry about it, again because I knew its not a chronic condition. Then in July I was admitted for a chronic condition, submitted a claim and it was REJECTED BECAUSE MY CHRONIC DAYS WERE USED. I then lodged a complaint with Clientele requesting for the recording in March where the assessor ADVISED ME SHE IS TAKING MY SEPTICEMIA ADMISSION FROM THE CHRONIC BENEFITS. These emails went back and forth with a very "intellectual" person named Jason Mey. According to him, my lupus "'could of caused" septicemia. I then requested proof from him that lupus caused septicemia. Considering I have a chemo port in my chest, possibilities are endless as to how one can contract septicemia. Again, I requested the recording. He sent me a recording that was done in September AFTER the complain. I explained on various occasions to him that I want the recording of March......he does not reply and after days I send a reminder then get a reply. When I pointed out that I have a port, he was too quick to write back stating that I should obtain a report from the doctor stating that septicemia was caused by the port and not lupus. I then asked if Clientele will absorb this cost and off course......his answer is NO. Now, number 1....there was NO CALL OR CONFIRMATION IN MARCH where I was advised septicemia was paid from the chronic benefit. Had you advised me then, I would of objected and sorted it out 7 months ago, instead of claim stage of a new claim. Number 2, you rejected a claim on what basis? You do not have proof that lupus caused septicemia but you rejected the claim anyway??????? How is this possible, the fact that Client used a word like "could of caused" that means you unsure. You are unsure what caused septicemia but you conveniently made it a chronic condition?????????? When assessing a claim, do you NOT LOOK AT ALL FACTS??????? Instead of how to get away from not paying a claim? Lets start looking at where the problem lies.......I WANT THE RECORDING FROM MARCH 2019 AND PLEASE DO NOT TELL ME ITS LOST
We confirm receipt of the concerns raised.
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,
Lindiwe Mabizela
Service Support Specialist
We confirm receipt of the concerns raised.
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,
Lindiwe Mabizela
Service Support Specialist
Please note that we have forwarded this query to the Independent Arbitrator and you can expect a response shortly. We trust this is all you require in this regard however, should you require further assistance please do not hesitate to contact us again.
Kind Regards, Lindiwe Mabizela Service Recovery Specialist
Please note that we have forwarded this query to the Independent Arbitrator and you can expect a response shortly. We trust this is all you require in this regard however, should you require further assistance please do not hesitate to contact us again.
Kind Regards, Lindiwe Mabizela Service Recovery Specialist
