PL
PJ L
1 reviews | Active since Apr 2018
10 Jul 2026, 09:44
Throwing money into water expecting a boat to rise from the water
It's like throwing money in the water expecting a boat to come from it
I pay for the day to day and the hospital cover with the extra heart option and all that. I've gone to a doctor on their network for about 4 times in the last year to get an email from them saying they only cover a certain amount for this doctor and I need to pay the outstanding fees... For a doctor on their own network that should be covered
I right now am having an emergency decided to come to the hospital for a doctor to just treat me. Episodic Health had to be phoned and because a network doctor didn't refer me they can only pay R2500 for this doctor/hospital visit and x-rays and blood tests are to be covered by me. It's 18:00 at night, I'm having an emergency and that's the response from them. I did pay for my x-rays that cost me R1464 and I won't be able to claim it back.
I pay R1100 a month for this plan and I'm realizing that it's not worth it. 4 doctor trips in a year and now 1 hospital trip to see a doctor.
I've been with them for 14 months and I've spent R 15 400 for a medical that at most cost them R4000. You're right if you're thinking I'm cancelling and can't recommend them at all. I cancelled this morning, my fiance cancelled this morning and a friend couple of ours also cancelled this morning. That's 4 cancellations because it's unfortunately a very bad medical scheme that you pay for and thinking everything is covered by their network but it's just not. It's like you're paying them to cover almost nothing
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Replies (4)0
Replies (4)
EssentialMED's replyOfficial
10 Jul 2026, 12:47Good day PJ L,
Thank you for bringing your concerns to our attention. We are sorry to hear about your experience and understand how stressful a medical emergency can be.
We have reviewed your membership and have contacted you directly via email regarding your Emergency Casualty benefit. We have also advised that your Guarantee of Payment can be amended to the full benefit available under your policy, subject to your confirmation, and have explained how the available benefit will be applied.
We appreciate the opportunity to address your concerns and look forward to assisting you further.
Kind regards,
EssentialMED Team
Thank you for bringing your concerns to our attention. We are sorry to hear about your experience and understand how stressful a medical emergency can be.
We have reviewed your membership and have contacted you directly via email regarding your Emergency Casualty benefit. We have also advised that your Guarantee of Payment can be amended to the full benefit available under your policy, subject to your confirmation, and have explained how the available benefit will be applied.
We appreciate the opportunity to address your concerns and look forward to assisting you further.
Kind regards,
EssentialMED Team
EssentialMED's reply10 Jul 2026, 12:47
Official
Good day PJ L,
Thank you for bringing your concerns to our attention. We are sorry to hear about your experience and understand how stressful a medical emergency can be.
We have reviewed your membership and have contacted you directly via email regarding your Emergency Casualty benefit. We have also advised that your Guarantee of Payment can be amended to the full benefit available under your policy, subject to your confirmation, and have explained how the available benefit will be applied.
We appreciate the opportunity to address your concerns and look forward to assisting you further.
Kind regards,
EssentialMED Team
Thank you for bringing your concerns to our attention. We are sorry to hear about your experience and understand how stressful a medical emergency can be.
We have reviewed your membership and have contacted you directly via email regarding your Emergency Casualty benefit. We have also advised that your Guarantee of Payment can be amended to the full benefit available under your policy, subject to your confirmation, and have explained how the available benefit will be applied.
We appreciate the opportunity to address your concerns and look forward to assisting you further.
Kind regards,
EssentialMED Team
PL
PJ L's updateReviewer Update
03 Aug 2026, 12:38Good day. We were chatting on email, thought I was going to pull the cancelation because I actually believed in you. Then last week I forward the bills to you and in the forward emails it tells you how to open the documents (using my ID number). The response I got was that it's password protected. I realized then and there that come Friday July 31 2026 had I actually saved my own money every month (R1085) instead of paying you I could have actually covered my own medical bills. From hospital to x-rays to the blood tests, which I realize today I actually have to pay myself as you paid nothing for my July 9 hospital visit (2 days before my bday). I am not angry, I am sad, I am disappointed. I wanted to give you another chance, I had heard such great things and so I joined but so I realized you just take my money and run leaving me having to pay anyway including your network doctor that I went to twice last year and twice this year. I wish you improvement for the future
PL
PJ L's update03 Aug 2026, 12:38
Reviewer Update
Good day. We were chatting on email, thought I was going to pull the cancelation because I actually believed in you. Then last week I forward the bills to you and in the forward emails it tells you how to open the documents (using my ID number). The response I got was that it's password protected. I realized then and there that come Friday July 31 2026 had I actually saved my own money every month (R1085) instead of paying you I could have actually covered my own medical bills. From hospital to x-rays to the blood tests, which I realize today I actually have to pay myself as you paid nothing for my July 9 hospital visit (2 days before my bday). I am not angry, I am sad, I am disappointed. I wanted to give you another chance, I had heard such great things and so I joined but so I realized you just take my money and run leaving me having to pay anyway including your network doctor that I went to twice last year and twice this year. I wish you improvement for the future
EssentialMED's replyOfficial
03 Aug 2026, 14:29Good day PJ L,
We understand your frustration regarding the costs incurred following your hospital visit and appreciate the opportunity to clarify the current status of your claim.
Please note that we have been in contact with Life Mercantile Hospital, who advised that the hospital account has not yet been finalised. They have explained that finalising accounts typically takes between 7 and 14 days after the date of service. Once the account has been completed, it will be submitted to EssentialMED for processing in accordance with your policy benefits.
Please be assured that our Claims Department is actively managing your case and is monitoring the outstanding hospital account. As soon as the finalised account is received from Life Mercantile Hospital, it will be assessed without delay in accordance with your policy benefits. We remain committed to keeping you updated throughout the process and to ensuring that your claim is handled as efficiently as possible.
Should you have any further questions or require assistance, please do not hesitate to contact us.
Kind regards,
EssentialMED Team
We understand your frustration regarding the costs incurred following your hospital visit and appreciate the opportunity to clarify the current status of your claim.
Please note that we have been in contact with Life Mercantile Hospital, who advised that the hospital account has not yet been finalised. They have explained that finalising accounts typically takes between 7 and 14 days after the date of service. Once the account has been completed, it will be submitted to EssentialMED for processing in accordance with your policy benefits.
Please be assured that our Claims Department is actively managing your case and is monitoring the outstanding hospital account. As soon as the finalised account is received from Life Mercantile Hospital, it will be assessed without delay in accordance with your policy benefits. We remain committed to keeping you updated throughout the process and to ensuring that your claim is handled as efficiently as possible.
Should you have any further questions or require assistance, please do not hesitate to contact us.
Kind regards,
EssentialMED Team
EssentialMED's reply03 Aug 2026, 14:29
Official
Good day PJ L,
We understand your frustration regarding the costs incurred following your hospital visit and appreciate the opportunity to clarify the current status of your claim.
Please note that we have been in contact with Life Mercantile Hospital, who advised that the hospital account has not yet been finalised. They have explained that finalising accounts typically takes between 7 and 14 days after the date of service. Once the account has been completed, it will be submitted to EssentialMED for processing in accordance with your policy benefits.
Please be assured that our Claims Department is actively managing your case and is monitoring the outstanding hospital account. As soon as the finalised account is received from Life Mercantile Hospital, it will be assessed without delay in accordance with your policy benefits. We remain committed to keeping you updated throughout the process and to ensuring that your claim is handled as efficiently as possible.
Should you have any further questions or require assistance, please do not hesitate to contact us.
Kind regards,
EssentialMED Team
We understand your frustration regarding the costs incurred following your hospital visit and appreciate the opportunity to clarify the current status of your claim.
Please note that we have been in contact with Life Mercantile Hospital, who advised that the hospital account has not yet been finalised. They have explained that finalising accounts typically takes between 7 and 14 days after the date of service. Once the account has been completed, it will be submitted to EssentialMED for processing in accordance with your policy benefits.
Please be assured that our Claims Department is actively managing your case and is monitoring the outstanding hospital account. As soon as the finalised account is received from Life Mercantile Hospital, it will be assessed without delay in accordance with your policy benefits. We remain committed to keeping you updated throughout the process and to ensuring that your claim is handled as efficiently as possible.
Should you have any further questions or require assistance, please do not hesitate to contact us.
Kind regards,
EssentialMED Team
PL
PJ L's updateReviewer Update
04 Aug 2026, 10:491135.00 I already have the statement. I also forward that email to you (your response was,
"Hi Peter Jeffrey Liebenberg,
Kindly note the document is password protected and we are unable to view the account, please resend with the relevant information for EssentialMED to assist further.")
I did forward the email to you with the email saying the password is my ID number. It is ok I understand you took my money and don't feel like paying or make your customers happy. Your customer satisfication is low, YES I WISH IT WOULD CHANGE, yes I do hope the best for you but untill then I think we're over. It is you, it is 100% you and not me, sorry
"Hi Peter Jeffrey Liebenberg,
Kindly note the document is password protected and we are unable to view the account, please resend with the relevant information for EssentialMED to assist further.")
I did forward the email to you with the email saying the password is my ID number. It is ok I understand you took my money and don't feel like paying or make your customers happy. Your customer satisfication is low, YES I WISH IT WOULD CHANGE, yes I do hope the best for you but untill then I think we're over. It is you, it is 100% you and not me, sorry
PL
PJ L's update04 Aug 2026, 10:49
Reviewer Update
1135.00 I already have the statement. I also forward that email to you (your response was,
"Hi Peter Jeffrey Liebenberg,
Kindly note the document is password protected and we are unable to view the account, please resend with the relevant information for EssentialMED to assist further.")
I did forward the email to you with the email saying the password is my ID number. It is ok I understand you took my money and don't feel like paying or make your customers happy. Your customer satisfication is low, YES I WISH IT WOULD CHANGE, yes I do hope the best for you but untill then I think we're over. It is you, it is 100% you and not me, sorry
"Hi Peter Jeffrey Liebenberg,
Kindly note the document is password protected and we are unable to view the account, please resend with the relevant information for EssentialMED to assist further.")
I did forward the email to you with the email saying the password is my ID number. It is ok I understand you took my money and don't feel like paying or make your customers happy. Your customer satisfication is low, YES I WISH IT WOULD CHANGE, yes I do hope the best for you but untill then I think we're over. It is you, it is 100% you and not me, sorry