AJ
Andre J

1 reviews | Active since Jul 2019

12 Nov 2020, 11:57

Health Risk

I came to a horrific discovery today. I was informed that the medication the eye specialist prescribed for my wife is not covered, this is in fact medication she has been using her whole life and is proven to work. I was informed that the specialist needs to send a motivation letter if he wants that specific medication to be approved by Elixi. Which he did. This was apparently not good enough as the doctor did not give clinical records to show that other medications do not work. The specialist does not want to take a chance on any other generic medication as the chance does exist she can go blind that is why he insisted on that specific medication. Percy from Elixi said that unless other medications are tried and proven not to work (even though she may go blind), then only may they look at approving the right medication (which is too late because the chance is by then she is blind). This shows the total disregard this medical insurance company have on its member's lives, they are willing to gamble a patient's life just to save a couple of bucks. When I wanted to speak to the manager I was informed that she does not take calls from clients and that currently she is on a call and the person I spoke to will ask whether she wishes to call me or not. When speaking to Percy I was informed that yes she does not speak to clients as she does not have a phone. How is it she does not have a phone but is on a call?? Once again showing the fact that they do not wish to deal with problems, they want your money yes, service delivery and care, non-existent. This is one company whose license should be pulled and the company closed down due to the health risk it poses to its members and or lack of care or consequence that a member may suffer.

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Replies (2)
Elixi
Elixi's reply12 Nov 2020, 12:47
Official
Dear Andre

Thank you for your review. 

We are sorry to hear this and apologize for the frustration and inconvenience caused.

Our Customer support team will be in contact with you shortly to discuss the matter further with you.

Regards
Elixi team
Elixi
Elixi's reply16 Nov 2020, 16:46
Official
Dear Andre

Thank you for allowing us the opportunity to investigate the matter.
 
As per your policy, the benefit for chronic medication is subject to a list of formulary medication. The Insurer was however willing to consider funding the medication not on the formulary should the doctor provide a motivation based on clinical information. They have not received sufficient information to consider funding the medication in question.

With regards to the manager not being available to take a call, with the company working from home, they have to connect members via Teams with the manager and not via a phone call. The manager was in another online meeting at the time and therefore could not take your call.

In order to process your application for the chronic medication, we require a motivation letter from the doctor detailing the clinical reason for not being able to use the medication available on the formulary. Should we receive the motivation, a funding decision can be made. 

We trust that you will find the above to be in order.

Regards
Elixi team