1 reviews | Active since Apr 2017

20 Apr 2017, 10:24

Incorrect Information / Poor response time on quires / Claim not paid

<p>Had to go see a dentist, was given dentist details to go see which is covered by them. Got to dentist, dentist made me pay R750.00 and told me to claim from Essential. Submitted claim got paid R120.00 from the R750.00 I paid being told it is an out of rate visit they do not cover it. Complained got one call from them asking a few questions, have not heard from them since. Nor would they pay the antibiotics the dentist had to prescribe me (R300+), was told they only cover medicine prescribed by a GP.</p> <p> </p> <p>They get paid their montly premuim but I am out of pocket by R900+ for going to a dentist they had told me to go to. </p> <p> </p> <p>This is not my first exceptionally poor experience with them. I would not recommend signing up them, I will most definitely be changing. There is always an issue with paying out claims, they make sure to find reasons not to pay you. </p>

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Replies (3)
EssentialMED
EssentialMED's reply20 Apr 2017, 11:46
Official

Good day,

Thank you for bringing your concerning matter under our attention.

Upon investigation we established that the practice claimed for one code. The administrators were in contact with the practice and have requested the detailed statement to see which codes was claimed. Once the requested statement is received then we will be able to review the claim.

The practice has been informed that they need to contact the administrators to confirm benefits before assisting a member as per codes that are covered by Our Dental Protocol.

Essential Med strives to provide the best service towards all our valued clients.

Kind regards,

Essential Med

's update24 Apr 2017, 15:35
Reviewer Update

And still NOTHING!!! You guys sux!

EssentialMED
EssentialMED's reply24 Apr 2017, 16:42
Official

Good day,

Thank you for bringing your concerning matter under out attention.

Elize was in contact with the practice and requested the detailed statement which will be send to Essential Med on the 25th of April 2017. Once the detailed statement is received then this claim will be reprocessed according to our Dental Protocol.

Essential Med strives in the best service delivery towards all our valued clients.

Kind regards,

Essential Med