1 reviews | Active since Jun 2016
Essential Med - Worst Medical Insurance in South Africa
<p>Really the worst company to deal with. If you want your loved ones to die while waiting for authorizations join them.</p> <p> </p> <p>Been a member for 3+ years and had two emergencies in that period. The first incident an R5 coin got stuck in my daughter's throat and I rushed her to the nearest hospital. Make a long story short they never authorized an ambulance nor the hospital. We paid cash and they never reimbursed a single cent. </p> <p> </p> <p>Yesterday took my daughter to their Dr. and he advised she must immediately be admitted to hospital as she had a very high fever. Again problems and 2 hours later no admission. The hospital wants R20 000 deposit as they say Essential Med is bad payers and Essential Med only want to authorize R10000. Eventually, Elize from Essential Med spoke to admission where it's arranged they will admit my child but she must be out by 12H00 the next day otherwise they want an extra R20 000.00 deposit.</p> <p> </p> <p>The child has been signed out at around 09H00 this morning luckily the fever was under control.</p> <p> </p> <p>This afternoon I receive a call from the same Elize informing me they are paying nothing. The child didn't spend 24 hours in the hospital.</p> <p> </p> <p>What a joke, the hospital said it's a day as they calculate from 12 to 12 as half day and then again 12-12 as another half day.</p> <p> </p> <p>You guys are taking on the wrong person. I'm reporting the matter to the insurance ombud and I will make it my mission to let the public know about your dubious business ethics.</p> <p> </p> <p>I've reserved the domain worstmedicalinsurance.co.za so watch this space.</p> <p> </p> <p> </p> <p> </p> <p> </p>
Thank you for brining your concerning matter under our attention.
When the first incident occur the HOD of Hospitals send an email to you on the 11th of December 2014 which you never responded to.Case notes on your policy reads as follows:
“I spoke to Mr Smit regarding his daughter. Client phoned Europ Assistance and they transferred the client to ER 24 at 5 past nine that evening. Client was at Sunward Park Hospital. No mention of Arwyp Medical Centre. The hospital phoned the ER 24 only after ten that was when the child swallowed the coin. I informed client that he can claim back from us. He would like to have a report regarding the incident. Provided client with my cellphone number as well as the afterhours number for should they have an emergency.”
You contacted our ER 24 yesterday afternoon regarding the admission. The GOP was send to the hospital and they were informed as stipulated on the GOP what the benefit is for every 24 consecutive hours a member spends in hospital. There was a conference call between yourself and Elize and she explained to you that the admission will be granted for 24 consecutive hours and a case update will be done today in order to confirm the treatment plan. Your daughter was discharged this morning which means the admission is less than 24 hours.
Therefore the claim is repudiated.
Essential Med strives in the best service delivery towards all our valued members.
Kind Regards
Essential Group
Thank you for brining your concerning matter under our attention.
When the first incident occur the HOD of Hospitals send an email to you on the 11th of December 2014 which you never responded to.Case notes on your policy reads as follows:
“I spoke to Mr Smit regarding his daughter. Client phoned Europ Assistance and they transferred the client to ER 24 at 5 past nine that evening. Client was at Sunward Park Hospital. No mention of Arwyp Medical Centre. The hospital phoned the ER 24 only after ten that was when the child swallowed the coin. I informed client that he can claim back from us. He would like to have a report regarding the incident. Provided client with my cellphone number as well as the afterhours number for should they have an emergency.”
You contacted our ER 24 yesterday afternoon regarding the admission. The GOP was send to the hospital and they were informed as stipulated on the GOP what the benefit is for every 24 consecutive hours a member spends in hospital. There was a conference call between yourself and Elize and she explained to you that the admission will be granted for 24 consecutive hours and a case update will be done today in order to confirm the treatment plan. Your daughter was discharged this morning which means the admission is less than 24 hours.
Therefore the claim is repudiated.
Essential Med strives in the best service delivery towards all our valued members.
Kind Regards
Essential Group