UNIVERSIAL COMPCARE

Review for UNIVERSIAL COMPCARE

I recently had a frustrating experience with UNIVERSIAL COMPCARE after an emergency admission to NETCARE in Kuilsriver on December 7, 2024. Despite being a network hospital, my medical aid refused to cover any of the costs, leaving me with a significant financial burden.

The circumstances surrounding my admission were urgent, and my boyfriend rushed me to the hospital after 9 pm. I was seen by Dr. Van Jaarsveld in the trauma unit, who ordered radiology tests, including CT scans and X-rays, to investigate my severe abdominal pain. Due to the severity of my condition, I was admitted to the hospital for two days Saturday evening for further management and observation.

Despite the hospital's efforts, the cause of my pain couldn't be determined during my stay, even after the tests. When the doctor recommended a gastroscopy and colonoscopy to further investigate, the medical aid declined coverage, and I was subsequently discharged without a diagnosis.

After discharge, the doctor requested that I undergo stool tests, which later revealed the presence of Helicobacter pylori bacteria in my stomach. Although the doctor was informed of the results and was supposed to contact me, the damage was already done – I was left with a significant financial burden due to the medical aid's refusal to cover costs.

The situation has left me with an overwhelming debt of over R17,000, which is crippling for me as a single mother. Despite following the advised procedures and submitting claims, each account was declined. This not only leaves me with a substantial financial burden but also means I won't be able to claim from my Gap Cover since nothing was paid.

To add insult to injury, I had followed the exact procedures advised by my medical aid to ensure coverage – going to a network hospital and being admitted – only to have all claims declined. This experience has made me question the value of having medical aid.

I'm not only sharing this review but also escalating the matter to the Medical Board due to the unfair treatment and lack of coverage for my hospital stay, despite having a hospital and day-to-day medical aid plan.

Given this experience, I'm losing faith in the system and wondering what the point of having medical aid is if claims are consistently declined despite following the rules. It's disheartening and financially crippling.

Recommendations for Improvement: - Review and improve claims processing to ensure timely and adequate coverage for members. - Provide clearer communication regarding network hospitals and coverage policies. - Consider revising policies to accommodate emergency situations where members may not have a choice in hospital selection. - Take responsibility for covering costs when members have followed advised procedures.