1 reviews | Active since Jan 2012
Claims not being paid
I submitted 2 claims on 16 January via email (***) and another claim around 22 January (***). I've had to phone 4 times to get a response our of discovery. Their answers are the same every time: the claim is not on the system, even after the call centre agent (Nick) who was extremely helpful and sent the claim through as well (***) on 4 Feb. There has been feedback after that date, on 5 Feb (Gosi @ 21:40)and 7 Feb (Nick @ 20:52), but the claim was still not on the system. The total of the claims are close to R3000.<br> <br> A call centre manager was supposed to phone me at 9:30 on Sunday 8 January 2015, but I have not received a call as of yet (it is now 11:23).<br> <br> I think it is unacceptable that I pay thousands of rands each month, but I need to wait weeks for basic claims that has always been paid in the past.
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there were any pre-existing conditions of which we were not aware.
We confirmed that our Standards Team have been in contact with you and discussed the details with you.
I understand that you may not be satisfied with the outcome of your query however it is in line with the Scheme rules.
Kind regards
Jashvir
Thank you for your comment.
When a member joins the Scheme, we process the application according to the information disclosed on the application. Once your membership is activated and we receive a request for either in or out of hospital authorisation within a certain period of time our system will automatically pend the request. We will then request further clinical information from your provider. This process is necessary to ascertain whether there were any pre-existing conditions of which we were not aware.
We confirmed that our Standards Team have been in contact with you and discussed the details with you.
I understand that you may not be satisfied with the outcome of your query however it is in line with the Scheme rules.
Kind regards
Jashvir