KM
Karabo M
1 reviews | Active since May 2018
25 Nov 2019, 10:42
False Advertising and Inconsistency
I cant believe how inconsistent these benefits are. One day they pay and then they don't pay the next day. Whats really disappointing is how they are never late in taking money out of my account, my account is up to date yet they wont pay a doctor thats on their list of doctors
Helpful (0)
Replies (4)0
Replies (4)
EssentialMED's replyOfficial
04 Dec 2019, 15:45Good day Karabo M,
Thank you for bringing your concern under our attention.
Communications was send out to all our clients with regards to GP authorisations that needs to be obtained once you have reached your limit for the year for a single or family.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
Thank you for bringing your concern under our attention.
Communications was send out to all our clients with regards to GP authorisations that needs to be obtained once you have reached your limit for the year for a single or family.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
EssentialMED's reply04 Dec 2019, 15:45
Official
Good day Karabo M,
Thank you for bringing your concern under our attention.
Communications was send out to all our clients with regards to GP authorisations that needs to be obtained once you have reached your limit for the year for a single or family.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
Thank you for bringing your concern under our attention.
Communications was send out to all our clients with regards to GP authorisations that needs to be obtained once you have reached your limit for the year for a single or family.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
KM
Karabo M's updateReviewer Update
06 Dec 2019, 13:19Thats not the issue at hand. The inconsistency in the claim paid and those that weren't paid is the first issue. When you get to a doc they call in to ensure you're still a member and that you're up to date with your payments. Furthermore they ensure that before i see the doc Essential Meds is ok with me seeing the doc. Tell me if I'm wrong.......
The fact that the rejected payments came back with a different reason initially is proof. The doctor in Roodepoort said i had ran out of benefits not that i didn't get authorisation. The funny thing is consultations after that were paid in full, how if i had ran out of benefits?
Top further compound your in consistencies why haven't you told your list of doctors not to consult unless authorisation has been obtained? Whats the point of giving them this card when we get to the consultation rooms? why do they refuse to see us when after 4pm ?
The fact that the rejected payments came back with a different reason initially is proof. The doctor in Roodepoort said i had ran out of benefits not that i didn't get authorisation. The funny thing is consultations after that were paid in full, how if i had ran out of benefits?
Top further compound your in consistencies why haven't you told your list of doctors not to consult unless authorisation has been obtained? Whats the point of giving them this card when we get to the consultation rooms? why do they refuse to see us when after 4pm ?
KM
Karabo M's update06 Dec 2019, 13:19
Reviewer Update
Thats not the issue at hand. The inconsistency in the claim paid and those that weren't paid is the first issue. When you get to a doc they call in to ensure you're still a member and that you're up to date with your payments. Furthermore they ensure that before i see the doc Essential Meds is ok with me seeing the doc. Tell me if I'm wrong.......
The fact that the rejected payments came back with a different reason initially is proof. The doctor in Roodepoort said i had ran out of benefits not that i didn't get authorisation. The funny thing is consultations after that were paid in full, how if i had ran out of benefits?
Top further compound your in consistencies why haven't you told your list of doctors not to consult unless authorisation has been obtained? Whats the point of giving them this card when we get to the consultation rooms? why do they refuse to see us when after 4pm ?
The fact that the rejected payments came back with a different reason initially is proof. The doctor in Roodepoort said i had ran out of benefits not that i didn't get authorisation. The funny thing is consultations after that were paid in full, how if i had ran out of benefits?
Top further compound your in consistencies why haven't you told your list of doctors not to consult unless authorisation has been obtained? Whats the point of giving them this card when we get to the consultation rooms? why do they refuse to see us when after 4pm ?
KM
Karabo M's updateReviewer Update
27 Dec 2019, 16:39My issue is still not resolved. no reply or even a suggested solution. nothing but debit order still goes off on time
KM
Karabo M's update27 Dec 2019, 16:39
Reviewer Update
My issue is still not resolved. no reply or even a suggested solution. nothing but debit order still goes off on time
EssentialMED's replyOfficial
30 Dec 2019, 08:39Good day Karabo M,
Before any GP consultation the practices needs to confirm benefits, whereby our consultants will advise the practice that the member is active and if and when a member needs authorisation.
If an account is short paid there is different reasons.
1. Authorisation needed
2. Tariff code claimed not covered into benefit plan
Claims are paid according to protocols that is in place and all the network providers have access to what they can claim for and what not. If the claim has been paid by the administrators the member is liable for the shortfall on the account.
The accounts that was that you are referring to has been paid according to the protocol, you as member will be liable for the difference. The other accounts that was rejected is due to no authorisation obtained.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
Before any GP consultation the practices needs to confirm benefits, whereby our consultants will advise the practice that the member is active and if and when a member needs authorisation.
If an account is short paid there is different reasons.
1. Authorisation needed
2. Tariff code claimed not covered into benefit plan
Claims are paid according to protocols that is in place and all the network providers have access to what they can claim for and what not. If the claim has been paid by the administrators the member is liable for the shortfall on the account.
The accounts that was that you are referring to has been paid according to the protocol, you as member will be liable for the difference. The other accounts that was rejected is due to no authorisation obtained.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
EssentialMED's reply30 Dec 2019, 08:39
Official
Good day Karabo M,
Before any GP consultation the practices needs to confirm benefits, whereby our consultants will advise the practice that the member is active and if and when a member needs authorisation.
If an account is short paid there is different reasons.
1. Authorisation needed
2. Tariff code claimed not covered into benefit plan
Claims are paid according to protocols that is in place and all the network providers have access to what they can claim for and what not. If the claim has been paid by the administrators the member is liable for the shortfall on the account.
The accounts that was that you are referring to has been paid according to the protocol, you as member will be liable for the difference. The other accounts that was rejected is due to no authorisation obtained.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize
Before any GP consultation the practices needs to confirm benefits, whereby our consultants will advise the practice that the member is active and if and when a member needs authorisation.
If an account is short paid there is different reasons.
1. Authorisation needed
2. Tariff code claimed not covered into benefit plan
Claims are paid according to protocols that is in place and all the network providers have access to what they can claim for and what not. If the claim has been paid by the administrators the member is liable for the shortfall on the account.
The accounts that was that you are referring to has been paid according to the protocol, you as member will be liable for the difference. The other accounts that was rejected is due to no authorisation obtained.
Essential Med strives in the best service delivery towards all our valued clients.
Kind Regards,
Elize