1 reviews | Active since Feb 2014
PREMIUM TAKEN 6 MONTHS AFTER SMS
I am irate to have Essential Med take a premium after 6 months of telling them that I cannot pay afford to pay the Doctors accounts and have a Hospital health Insurance that doesn't cover for emergencies.<br> My son went into hospital for an emergency appendix op that was going to burst, they paid only R6 500 towards the hospital account, they didn't pay the Doctor/Anesthetist and Pathologist account, let alone I still have to pay the balance of the hospital account= + -R24k <br> When I stopped my premiums, I also got accounts from PoliClinic that was not covered when EM moved from 1 Doctor, which I also now have to pay.<br> Coxen & Partners Handed me over, Doctor Botha was understanding.<br> They then have the audacity to tell me that I will not be refunded, and I have been sending them numerous emails requesting what they are actually covering after 6 months!!! EMAILS IGNORED!!!<br> I will go legal with them and I will let everyone know to please make sure that you do not deal with EM, as an emergency to them is a broken hand which they covered everything but a life threatening appendix op is not considered an emergency and they only pay a portion.<br> <br> WHO DECIDES WHAT IS AN EMERGENCY AND WHAT ISN'T!
Thank you for bringing the concerning matter to our attention.
With regards to your hospital claim for your son's emergency admission the stated benefits was paid out to the hospital. When a client gets admitted to hospital even if it is an emergency all the treatment in hospital must be covered under the authorsation number as well as the benefit. If the benefits are not enough you as the client must cover all the shortfalls to the hospital and the providers in hospital. Therefore, we cannot utilize your day to day benefits to cover the costs for the Doctors, Pathologist and the Anesthetist as the two departments are being administered by two different entities.
The reason as to why your husband's claim was covered is that his admission was due to an accident and the benefit payout is much more than normal illness admission.
Please do not hesitate to contact any of our friendly consultants who will assist you.
Kind regards,
Essential Group
Thank you for bringing the concerning matter to our attention.
With regards to your hospital claim for your son's emergency admission the stated benefits was paid out to the hospital. When a client gets admitted to hospital even if it is an emergency all the treatment in hospital must be covered under the authorsation number as well as the benefit. If the benefits are not enough you as the client must cover all the shortfalls to the hospital and the providers in hospital. Therefore, we cannot utilize your day to day benefits to cover the costs for the Doctors, Pathologist and the Anesthetist as the two departments are being administered by two different entities.
The reason as to why your husband's claim was covered is that his admission was due to an accident and the benefit payout is much more than normal illness admission.
Please do not hesitate to contact any of our friendly consultants who will assist you.
Kind regards,
Essential Group