SL
Sarah L
1 reviews | Active since Nov 2018
19 Nov 2018, 11:51
Unnecessary stress. Waste of money.
Please Read This before signing up with Compcare !
Like with any medical aid scheme there is always a procedure to follow in order to successfully claim back your money spent, with Compcare however the claim procedure is literally designed to make you give up ... long story short I have been with compare for 4 years now as a student and although i always paid i never needed to consult or anything. In July i was experiencing problems and saw a professional who recommended a radiology and so I proceeded. I went home and still had the same problems so i decided to seek a second opinion and i was right in doing so because they found a cyst in my uterus. In Total i spent about R2800 and so decided to claim back. Compare personnel had me submit forms about 4 times between August and November and each time the documents either got lost or the person handling my case "quit" so I had to start all over again. On the 12th i was finally told that i would probably be reimbursed on a Friday so i gave it time and decided to check on Monday 19th; I got directed to a lady from authorizations who finally told me that my entire claim case was null and void if i couldn't provide a letter from the first GP i saw in july, mind you the GP is in Port Elizabeth and her consultation fee in order to just get an appointment is R800
In summary, they'll throw you around like a ball of ping pong only to tell you that you have no chance of getting a penny back.
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Replies (4)0
Replies (4)
CompCare Medical Scheme's replyOfficial
03 Jan 2019, 15:30Good day Sarah
Thank you for bringing this matter to our attention. We were most concerned to receive your message and fully understand your concerns. Please provide us with your membership number and contact details in a private inbox message in order for us to look into this matter.
Kind regards
The CompCare Wellness Medical Scheme customer experience team
CompCare Medical Scheme's reply03 Jan 2019, 15:30
Official
Good day Sarah
Thank you for bringing this matter to our attention. We were most concerned to receive your message and fully understand your concerns. Please provide us with your membership number and contact details in a private inbox message in order for us to look into this matter.
Kind regards
The CompCare Wellness Medical Scheme customer experience team
CompCare Medical Scheme's replyOfficial
14 Jan 2019, 10:41Good day, Sarah
Thank you for providing CompCare Wellness Medical Scheme with the opportunity to look into the matter. Upon investigation, the following was found:
The member joined the Scheme on 01/01/2017 until 01/01/2018 under the name Sarah Feza. Ms Lingomo re-joined the Scheme under her current name from 01/05/2018 until 01/01/2019.
There are three reference numbers on the system for this query:
· Reference number ***: Ms Lingomo enquired whether the claim was on the system. An agent advised her to email the claim to ***.
· Reference number ***: CompCare Wellness Medical Scheme received the claim and it was sent through for processing.
· Reference number ***: The Scheme advised the member that the claim was rejected due to not obtaining an authorisation number for a specialist referral.
The total amount of the claims that was paid is for the amount of R2 480.00.
The member was called and asked for the general practitioner claim. Ms Lingomo stated that she had lost it and that she would go to the general practitioner to obtain the claim.
Kindly take note the CompCare Wellness brochure stipulates “A referral from a GP is required before seeking treatment from a specialist except for services provided by an ophthalmologist, gynaecologist, oncologist or urologist (for beneficiaries over the age of 40) and a paediatrician in respect of children under the age of 2 years or where multiple visits to a specialist are authorised.”
In order for the Scheme to reprocess the claim, it would be imperative to provide CompCare Wellness with the referral letter from the GP.
Kind regards
The CompCare Wellness customer experience team
CompCare Medical Scheme's reply14 Jan 2019, 10:41
Official
Good day, Sarah
Thank you for providing CompCare Wellness Medical Scheme with the opportunity to look into the matter. Upon investigation, the following was found:
The member joined the Scheme on 01/01/2017 until 01/01/2018 under the name Sarah Feza. Ms Lingomo re-joined the Scheme under her current name from 01/05/2018 until 01/01/2019.
There are three reference numbers on the system for this query:
· Reference number ***: Ms Lingomo enquired whether the claim was on the system. An agent advised her to email the claim to ***.
· Reference number ***: CompCare Wellness Medical Scheme received the claim and it was sent through for processing.
· Reference number ***: The Scheme advised the member that the claim was rejected due to not obtaining an authorisation number for a specialist referral.
The total amount of the claims that was paid is for the amount of R2 480.00.
The member was called and asked for the general practitioner claim. Ms Lingomo stated that she had lost it and that she would go to the general practitioner to obtain the claim.
Kindly take note the CompCare Wellness brochure stipulates “A referral from a GP is required before seeking treatment from a specialist except for services provided by an ophthalmologist, gynaecologist, oncologist or urologist (for beneficiaries over the age of 40) and a paediatrician in respect of children under the age of 2 years or where multiple visits to a specialist are authorised.”
In order for the Scheme to reprocess the claim, it would be imperative to provide CompCare Wellness with the referral letter from the GP.
Kind regards
The CompCare Wellness customer experience team
SL
Sarah L's updateReviewer Update
31 Jul 2019, 21:11If you're going to reply to a complaint at least make sure your facts are straight !
The document you required wasn't lost, I told the agent i spoke to that I had moved across the state from the Eastern cape to the western cape and that i would basically need to go back to get it or at least obtain a copy. You've only addressed one of the claims but i seem to recall having contacted Compcare with several claims! It got so bad that my GP's office would refuse to get on the phone with your people because she said she had never had so much trouble dealing with a Medical scheme company ... I was often told by my doctor when it came to Compcare that they would rather I contact your company myself because they never got their money if they treated your company's clients - to end i'll say this - Your team wouldn't have contacted me to try to finally have a second look at the documents i presented if they hadn't felt that my case was handled poorly!
Just do better !! and do present your customers with whatever T&Cs you always refer to have once the customer starts claiming. I could send you all the communication i had with your team while trying to acquire a medical scheme and I promise you there were no comments about requiring an " authorisation number for a specialist referral".
The document you required wasn't lost, I told the agent i spoke to that I had moved across the state from the Eastern cape to the western cape and that i would basically need to go back to get it or at least obtain a copy. You've only addressed one of the claims but i seem to recall having contacted Compcare with several claims! It got so bad that my GP's office would refuse to get on the phone with your people because she said she had never had so much trouble dealing with a Medical scheme company ... I was often told by my doctor when it came to Compcare that they would rather I contact your company myself because they never got their money if they treated your company's clients - to end i'll say this - Your team wouldn't have contacted me to try to finally have a second look at the documents i presented if they hadn't felt that my case was handled poorly!
Just do better !! and do present your customers with whatever T&Cs you always refer to have once the customer starts claiming. I could send you all the communication i had with your team while trying to acquire a medical scheme and I promise you there were no comments about requiring an " authorisation number for a specialist referral".
SL
Sarah L's update31 Jul 2019, 21:11
Reviewer Update
If you're going to reply to a complaint at least make sure your facts are straight !
The document you required wasn't lost, I told the agent i spoke to that I had moved across the state from the Eastern cape to the western cape and that i would basically need to go back to get it or at least obtain a copy. You've only addressed one of the claims but i seem to recall having contacted Compcare with several claims! It got so bad that my GP's office would refuse to get on the phone with your people because she said she had never had so much trouble dealing with a Medical scheme company ... I was often told by my doctor when it came to Compcare that they would rather I contact your company myself because they never got their money if they treated your company's clients - to end i'll say this - Your team wouldn't have contacted me to try to finally have a second look at the documents i presented if they hadn't felt that my case was handled poorly!
Just do better !! and do present your customers with whatever T&Cs you always refer to have once the customer starts claiming. I could send you all the communication i had with your team while trying to acquire a medical scheme and I promise you there were no comments about requiring an " authorisation number for a specialist referral".
The document you required wasn't lost, I told the agent i spoke to that I had moved across the state from the Eastern cape to the western cape and that i would basically need to go back to get it or at least obtain a copy. You've only addressed one of the claims but i seem to recall having contacted Compcare with several claims! It got so bad that my GP's office would refuse to get on the phone with your people because she said she had never had so much trouble dealing with a Medical scheme company ... I was often told by my doctor when it came to Compcare that they would rather I contact your company myself because they never got their money if they treated your company's clients - to end i'll say this - Your team wouldn't have contacted me to try to finally have a second look at the documents i presented if they hadn't felt that my case was handled poorly!
Just do better !! and do present your customers with whatever T&Cs you always refer to have once the customer starts claiming. I could send you all the communication i had with your team while trying to acquire a medical scheme and I promise you there were no comments about requiring an " authorisation number for a specialist referral".
CompCare Medical Scheme's replyOfficial
01 Aug 2019, 15:37Good afternoon Sarah,
We are sorry to hear about your experience. Thank you for your message. We are looking into the matter and will get back to you as soon as possible.
Kind regards
The CompCare Wellness customer experience team
We are sorry to hear about your experience. Thank you for your message. We are looking into the matter and will get back to you as soon as possible.
Kind regards
The CompCare Wellness customer experience team
CompCare Medical Scheme's reply01 Aug 2019, 15:37
Official
Good afternoon Sarah,
We are sorry to hear about your experience. Thank you for your message. We are looking into the matter and will get back to you as soon as possible.
Kind regards
The CompCare Wellness customer experience team
We are sorry to hear about your experience. Thank you for your message. We are looking into the matter and will get back to you as soon as possible.
Kind regards
The CompCare Wellness customer experience team