1 reviews | Active since Aug 2012
Items not covered
I'm so disappointed in this medical aid, I'm on key care plus and I might as well not be on it. I was involved in a very horrible car accident and obviously rushed to Hospital. I was on bed rest for a whole week after the accident and my car has since been written off, today is my 1st day @ work and I've just received an sms from Silas Gidzha Partner which reads: No cover for neck collar you received amount is due R300.00, due date 30/092015<br> I don't understand why something like this isn't covered, this is not something one walks to hospital and requests for just for the seek of requesting it. I pay my medical aid premium every month thinking I will get the best health care should I need it, but now that time has come only to find that something so essential isn't covered. I don't understand, I just don't get why this is the case. I doubt anyone can explain something I could understand regarding this!
Thank you for your patience while I investigated your query.
I confirmed that based on your chosen plan type, external medical items are covered from your available day to day benefits. However, your plan does not make provision for funding of these day to day items and therefore the claim was not paid. I discussed the clinical nature of your case with our Medical Review Team and we have made an exception given the clinical information of your treatment to fund your claim in full. Payment will be made to the provider within their next payment cycle. Also, an updated claims notification will be sent to you confirming the claims we processed.
Kind regards
Bruce
Thank you for your patience while I investigated your query.
I confirmed that based on your chosen plan type, external medical items are covered from your available day to day benefits. However, your plan does not make provision for funding of these day to day items and therefore the claim was not paid. I discussed the clinical nature of your case with our Medical Review Team and we have made an exception given the clinical information of your treatment to fund your claim in full. Payment will be made to the provider within their next payment cycle. Also, an updated claims notification will be sent to you confirming the claims we processed.
Kind regards
Bruce