1 reviews | Active since Sept 2012
Be very careful for cheap medical funds : Essential Med
<p>I have been a member with Essential Med from 2012. I don't go much to doctors, but kept the medical aid. This year I was hospitalized, and what they do advertise is that it is an unlimited medical insurance. But what they don't say is that when you go to hospital, they will only pay whatever they decide, and the doctors that treat you will be excluded. My bills were R147 000 of which they only paid R40 500.00. When querying them, they told me that that is all they will pay! Do not take out medical insurance from them. The doctors and medical providers, including hospitals do not accept them, as they have gained a reputation for not paying bills. Needless to say, I have cancelled my membership! When something is too good to be true, be sure that is what it is. There is no such thing as anything that is cheap, that pays for medical bills. They do not respond to any queries and do not give out the correct information from the beginning.</p>
Good day,
Thank you for bringing your concerning matter under our attention.
Upon investigation we can see that authorization was granted for the admission and according to our stated benefits.
The procedure you went for is normally a 3 days stay whereby the benefit is payable for 72 consecutive hours. The HOD was in contact with your husband regarding the admission and confirmed that the stated benefits will be paid and an additional amount. The additional amount that was agreed on for the admission is because you are a long standing member of Essential Med that we value.
These amounts was paid out to you as member as you have paid an amount to the hospital when you were admitted.
Your stay however was for 10 days and only three days was authorized. The hospital had to give us a case update and if further authorization was needed they had to request it which was not done. You were in contact with the General Managers of the Medical Support Department and confirmation was given that we will cover the stated benefits for three days as well as the additional amount for the admission.
Anything that is done in hospital or is relating to the hospital admission must be within the stated benefits if it is more then you as member will be liable for the costs. When accounts is submitted to Essential Med we state in our documentation that it takes 30 working days in order to process a claim.
Investigation was done to establish what was the reason that you were admitted longer than the authorized days once that was completed then only was the accounts processed and paid accordingly.
Unfortunately Essential Med covers stated benefits for admissions that is longer than 24 consecutive hours and according to the plan that you are on.
Essential Med is a Medical Health Insurance and not a Medical Aid. Essential Med strives in the best service delivery towards all our valued clients.
Kind regards
Essential Group
Good day,
Thank you for bringing your concerning matter under our attention.
Upon investigation we can see that authorization was granted for the admission and according to our stated benefits.
The procedure you went for is normally a 3 days stay whereby the benefit is payable for 72 consecutive hours. The HOD was in contact with your husband regarding the admission and confirmed that the stated benefits will be paid and an additional amount. The additional amount that was agreed on for the admission is because you are a long standing member of Essential Med that we value.
These amounts was paid out to you as member as you have paid an amount to the hospital when you were admitted.
Your stay however was for 10 days and only three days was authorized. The hospital had to give us a case update and if further authorization was needed they had to request it which was not done. You were in contact with the General Managers of the Medical Support Department and confirmation was given that we will cover the stated benefits for three days as well as the additional amount for the admission.
Anything that is done in hospital or is relating to the hospital admission must be within the stated benefits if it is more then you as member will be liable for the costs. When accounts is submitted to Essential Med we state in our documentation that it takes 30 working days in order to process a claim.
Investigation was done to establish what was the reason that you were admitted longer than the authorized days once that was completed then only was the accounts processed and paid accordingly.
Unfortunately Essential Med covers stated benefits for admissions that is longer than 24 consecutive hours and according to the plan that you are on.
Essential Med is a Medical Health Insurance and not a Medical Aid. Essential Med strives in the best service delivery towards all our valued clients.
Kind regards
Essential Group