1 reviews | Active since Oct 2017
Essential med worst medical insurance
I am on the highest package of essential med and I know that it is not a medical aid but when signing up I was told about unlimited doctors visits, pathology, dental visits etc. But since the first time I used the pathology services I had to pay out of my own pocket because apparently if you visit the doctor/dentist and use the pathology they will only pay for one service. Which no one told us! So there I was going to the doctor and the following week for blood tests and guess what they didn't pay for the blood test. Every month I get a bill from pathcare stating that essential med rejected the payment of R185 so every month I have to pay it. They refuse to pay R185 but yet every month we have to pay essential med R1700! I also went to the dentist, only to find out that my dental cover only allows for 3 fillings, 2 cleaning and extraction per year. Oh and if you are admitted to hospital for tests, they don't cover it. I had to pay for tests and a specialist out of my own pocket because they only give R1500 per year for a specialist (that's 1 visit at a specialist). So for this whole year we basically paid R1700 for unlimited doctors visits that costs about R300 so I might as well cancel this and put that money in my account for emergencies seen as I am already paying for everything myself!
Good day ,
Thank you for bringing your concerning matter under our attention.
Our claims official was in contact with the main member and explained that we cover the Dentistry, Pathology and Radiology according to a Protocol.
We don't have signed agreements with the Radiologist and Pathologists practices and they do charge more than what is covered from Essential Meds side. Regarding dentistry we cover basic dentistry and the practice needs to confirm benefits before they can assist our members.
When a member gets admitted to hospital there must be a fixed diagnosis in place in order to treat the condition that the member were diagnosed with.
Essential Med strives to provide quality service towards all our valued clients.
Kind regards,
Essential Med
Good day ,
Thank you for bringing your concerning matter under our attention.
Our claims official was in contact with the main member and explained that we cover the Dentistry, Pathology and Radiology according to a Protocol.
We don't have signed agreements with the Radiologist and Pathologists practices and they do charge more than what is covered from Essential Meds side. Regarding dentistry we cover basic dentistry and the practice needs to confirm benefits before they can assist our members.
When a member gets admitted to hospital there must be a fixed diagnosis in place in order to treat the condition that the member were diagnosed with.
Essential Med strives to provide quality service towards all our valued clients.
Kind regards,
Essential Med
