FG
Fritz G

1 reviews | Active since Mar 2017

12 Feb 2018, 08:21

Misleading terms - poor customer service

I have a variety of issues, chief among them is that upon joining Essential Med I was advised that after a 12 month waiting period I would be entitled to visit an Optometrist for an eye test, single vision lenses and frames. However, when I inquired if there was a cap on the value of the frame I can choose I was informed that this amount is only R150.00 and that Essential Med only uses Specsavers. I was dumbfounded as to why I was not informed of the cap before joining and and how a cap can be so low. Specsavers does not even stock frames on their website for under R600.00.

I have logged a previous complaint on Hello Peter and Essential Med could not give me a straight answer, they chose to beat around the bush in a very polite fashion and now they are simply ignoring me.

This is poor service and utterly misleading terms. If there is anyone reading this and considering instituting a class suit please contact me.

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Replies (2)
EssentialMED
EssentialMED's reply12 Feb 2018, 11:34
Official

Thank you for bringing your concerning matter under our attention.

When the compliance was done the consultant asked if you understand the benefits and you confirmed. Specsavers is aware what is covered as they need to phone to confirm benefits.

The breakdown for Optometry is as follows:

A Health Insurance Product and not a Medical Aid

Essential Med members may visit any Spec-Savers. In the event of there not being a Spec-Savers in the area, please contact us and we will assist you with an alternative, approved provider.
In a 24 month cycle each beneficiary is entitled to the following:

2017 RATES

CONSULTATIONS

A consultation consists of Refraction, Tonometry, Visual field screening and Dispensing within the benefit, at an approved provider to the value of R469.

SPECTACLES

Frames: R150 Frame or lens enhancements (SAOS frame code 40501)

Clear Spectacle Lenses:


Single Vision Lenses 2 x R165.00 per lens (SSSA code 80001)

Anything above the breakdown the member will be liable for.


Essential Med is bound by the Policy wording and the benefits.

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


Kind Regards,

Essential Med

FG
Fritz G's update12 Feb 2018, 13:22
Reviewer Update
I understood the benefits as it is specified on my policy. Any limitations to the benefits were not set out on the policy nor was it ever communicated to me. I once again state that I am happy Specsavers and the other third party service providers know of the caps/limitations however the problem is that we as the consumers were never notified/informed of the limitations to our coverage and therefore misled. This is simply unacceptable!!