1 reviews | Active since Jul 2017

10 Jan 2020, 12:24

Medical Insurance from hell

On Thursday (19 December) I began getting stomach cramps, then slight diarrhea. I drank flat coke and dismissed this as a passing issue as I was still in shock and at Edenvale hospital following the passing of my grandmother who had left us earlier that day. On Friday the stomach cramps intensified, the diarrhea was ongoing, but there was still no time to attend to my health concern as there were now people to attend to and burial arrangements to sort out.By Friday evening not only did I have diarrhea but I now had the shivers and a slight fever. I tried a few more home remedies and hoped I'd be fine in the morning.This was not the case. By Saturday it seemed the worst was over, I was a bit weak but there were no shivers, just cramps and diarrhea. I went home with my 2-year old son and after putting him to bed I could feel that I was becoming weaker, i was also feeling very cold, so i went into the blankets.I noticed that my temperature was going up and my stomach cramps were becoming severe.I called my neighbor as it was just my son and I in the house and I was worried about him if anything happened to me. I also dialed the 24/7 doctor number i found in my policy documents. I thought I was speaking to a doctor only to find that it was an emergency number. I told the lady on the line my emergency and she asked whether I wanted to speak to a doctor or to be transferred to ER24. I told her that I needed to know whether I needed a hospital at that time or not. She told me that the choice was mine. I asked for ER24 as I thought if it wasn't an emergency they would better advise me while on the scene. To cut a long story short, the medics arrived,examined me, told me my temp was 38 degrees and that I needed medical attention immediately. I told them I used Elixi, they tried getting a hold of Elixi to verify where they could take me but could not. The Paramedics who had never heard of Elixi were told by their senior that Elixi worked hand in hand with Life hospitals but that they should call Arwyp Hospital to see if they could assist me. If they could not, then they should transport me to a Life Hospital. The nearest being either Primrose or Benoni. On this instruction they called Arwyp as they could still not get a hold of Elixi. Arwyp told them they needed a GOP, at this stage they were worried about my escalating temperature and took me to Arwyp, in the hopes that Elixi would eventually pick up and assist with a GOP.This was not the case.We arrived at Arwyp where I was attended.to immediately and put on three drips.The paramedics left me in the hands of the emergency unit. Just as a nurse came in to draw blood for blood tests as per the doctors orders, a receptionist also walked in to inform me that they still could not get a hold of Elixi and that I would have to foot my hospital bill. I was mortified as another emergency had just just arisen (My grandmother's funeral), which I would have to contribute towards. I asked to please continue contacting Elixi on all their numbers, It was after 1am. I was weak and drowsy due to the illness and medication but managed to go into my emails, looking for any and every number. I eventually dozed off only to be abruptly woken up by another lady who insisted that I open a file, and give them my details as they still could not get a hold of Elixi. I gave her all the necessary information and slept. Eventually the receptionist came to inform me that they had finally gotten a hold of Elixi and had been told that a GOP would not be granted as my illness had started on Thursday and I had not gone to a GP first. I find this to be extremely unreasonable. I have contacted Elixi under Unity Health to request the exact clause that stipulates that I need to start at a GP in a case of emergency or else I will not be attended to or covered and to this date no one has contacted me. I have sent complaints to their various emails, the only time they tried contacting me is when I sent a cancellation of policy email. This is extremely disturbing.Do not use Elixi Medical Insurance.Service is horrible and terms and conditions are unreasonable.

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Replies (2)
Elixi
Elixi's reply10 Jan 2020, 12:49
Official
Dear Tumelo

Thank you for reaching out to us.

Your query has been forwarded to our customer support team for urgent attention on the matter and they will be in contact with you shortly to discuss the matter further with you.

Regards
Elixi
Elixi
Elixi's reply15 Jan 2020, 11:37
Official
Dear Tumelo,

Thank you for discussing your query with us. As mentioned, the Casualty benefit is applicable in the event of an Emergency as defined in your policy wording - Emergency is an event of a sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment , where failure to provide medical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the Insured Person’s life in jeopardy.

Regrettably in this instance your condition was imminent and as a result of untreated symptoms presented in the days prior to you seeking medical treatment and therefore not meeting the definition of an Emergency as set out in your policy wording.

We regret that our response in unfavourable however we trust that will find the above to be in order.

Regards
Elixi team