1 reviews | Active since May 2016
Claim not paid
<p>I went to see the Dr in October last year. They submitted the claim and everything. Months went past and I honestly had no idea that the medical aid did not pay. On the 14th of Feb I received a call from lawyers that I was handed over,. I was dumbstruck at this new information. I immedately got on the phone with the medical aid and they said they would get back to me. 30 days later (after back and fourth communication) I get told that it is an out of network doctort AND it is over the 90 days so I cannot claim back. I do not mind paying first but this was not my fault. The provider was negligent and so was the medical aid by waiting 30 days to tell me that it is an out of network doctor!!! I had to cover lawyer fees AND the doctors fees!!!!! I find this to be completely unacceptable. I pay my monthy fee for a service not to do all the work for you guys</p>
Good day,
Thank you for bringing your concerning matter under our attention. Upon investigation it was established that the provider was and is not part of the Network of providers. Before any provider assist an Essential Med member they need to phone to confirm benefits and if they did we would have advised them that they are not part of the Network. You can also take it up with the practice to see how they can assist with the amount and the lawyers costs. Essential Med strives in the best service delivery towards all our valued members.
Kind regards,
Essential Med
Good day,
Thank you for bringing your concerning matter under our attention. Upon investigation it was established that the provider was and is not part of the Network of providers. Before any provider assist an Essential Med member they need to phone to confirm benefits and if they did we would have advised them that they are not part of the Network. You can also take it up with the practice to see how they can assist with the amount and the lawyers costs. Essential Med strives in the best service delivery towards all our valued members.
Kind regards,
Essential Med
Good day
Im sorry but I think this is unacceptable. You guys could have also sent me a remittance to say that is was rejected!
Good day
Im sorry but I think this is unacceptable. You guys could have also sent me a remittance to say that is was rejected!
Good day,
The account in question was only received on the 14th of February 2017. The account was send to the administrators on the same day. Follow up was done on the 23rd of February 2017 regarding the claim as it was still in for processing this only means that the claim is attended to not to be paid.
On the 3rd of March 2017 follow up was done again regarding the claim. We were then informed that the account is stale and will not be settled. Our consultant send an email on the 6th of March 2017 to inform you that the claim is stale and you as member will be liable for the costs.
Essential Med strives in the best service delivery towards all our valued clients.
Kind regards,
Essential Med
Good day,
The account in question was only received on the 14th of February 2017. The account was send to the administrators on the same day. Follow up was done on the 23rd of February 2017 regarding the claim as it was still in for processing this only means that the claim is attended to not to be paid.
On the 3rd of March 2017 follow up was done again regarding the claim. We were then informed that the account is stale and will not be settled. Our consultant send an email on the 6th of March 2017 to inform you that the claim is stale and you as member will be liable for the costs.
Essential Med strives in the best service delivery towards all our valued clients.
Kind regards,
Essential Med