PC
Peggy C

1 reviews | Active since Sept 2017

13 Sept 2017, 15:35

Hospital Addition

I accepted a policy on 01/08/2017 with Essential Med. On acceptance I received a letter stating that I only have a waiting period for 30 days on Hospitalisation and day to day benefits.

Now that I have to claim for a procedure that is not covered at this stage and is excluded for 12 months which was not noted on the letter.

Now I have to pay for the procedure out of my pocket which coast R45 000.00 and I do not have the funds for this.

This is really bad for business

0
Replies (4)
EssentialMED
EssentialMED's reply13 Sept 2017, 16:07
Official

Good day,

Thank you for bringing your concerning matter under our attention.

Our claims department is attending to the request for the authorisation. Unfortunately procedures need to be followed in order to rule out any pre-existing conditions. The waiting period for the daily cash benefit was waived however the stated conditions have a 12 and 24 month waiting period which is still applicable.

The waiting periods are as follows:

3 month waiting period for the daily cash benefit. 12 month waiting period for stated conditions and a 24 month waiting period for hysterectomy.

Essential Med strives to provide quality service to all our valued clients.

Kind regards,

Essential Med

PC
Peggy C's update13 Sept 2017, 16:18
Reviewer Update
The letter received did not state that is was only for the Daily Cash, it was said Hospital and according to the wording that is included under the Hospital section
EssentialMED
EssentialMED's reply13 Sept 2017, 16:27
Official

Good day,

Once the necessary information is obtained and everything has been investigated, we will revert back to you.

Kind regards,

Essential Med

PC
Peggy C's update18 Sept 2017, 16:15
Reviewer Update
Thank you for the claim being paid