DvdM
Dewet van der Merwe
1 reviews | Active since Dec 2012
19 Oct 2015, 17:37
Always have excuses as to why claims are not paid
This is not the first time that they only partially pay a claim and when I queried it they have one excuse after the other. The latest excuse is that we made use of a dentist not being on their network. This after we phoned the number on the list they provided us with. In addition to this I practically always have to beg them to give me feedback on any query I might have. So disgusted in them. Will be looking for alternative insurance.
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EssentialMED's replyOfficial
20 Oct 2015, 12:49Hello wolmaestro,
Thank you for bringing the concerning matter to our attention.
We would like to refer you to your complaint whereby your stipulated that we did pay on the account but it was partially paid. The reason as to why the account was paid partially is that we pay the benefits according to our Benefit Structure. If you as client make use of a Provider not on the network you have to pay cash and claim back whereby we will reimburse you according to the Benefit Structure.
If an account is partially paid it means that the providers have done or requested codes that is not according to our Benefit structure and they will advise you accordingly.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Essential Group
Thank you for bringing the concerning matter to our attention.
We would like to refer you to your complaint whereby your stipulated that we did pay on the account but it was partially paid. The reason as to why the account was paid partially is that we pay the benefits according to our Benefit Structure. If you as client make use of a Provider not on the network you have to pay cash and claim back whereby we will reimburse you according to the Benefit Structure.
If an account is partially paid it means that the providers have done or requested codes that is not according to our Benefit structure and they will advise you accordingly.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Essential Group
EssentialMED's reply20 Oct 2015, 12:49
Official
Hello wolmaestro,
Thank you for bringing the concerning matter to our attention.
We would like to refer you to your complaint whereby your stipulated that we did pay on the account but it was partially paid. The reason as to why the account was paid partially is that we pay the benefits according to our Benefit Structure. If you as client make use of a Provider not on the network you have to pay cash and claim back whereby we will reimburse you according to the Benefit Structure.
If an account is partially paid it means that the providers have done or requested codes that is not according to our Benefit structure and they will advise you accordingly.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Essential Group
Thank you for bringing the concerning matter to our attention.
We would like to refer you to your complaint whereby your stipulated that we did pay on the account but it was partially paid. The reason as to why the account was paid partially is that we pay the benefits according to our Benefit Structure. If you as client make use of a Provider not on the network you have to pay cash and claim back whereby we will reimburse you according to the Benefit Structure.
If an account is partially paid it means that the providers have done or requested codes that is not according to our Benefit structure and they will advise you accordingly.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Essential Group