RG
Reema G

1 reviews | Active since Nov 2013

11 Jun 2018, 10:36

UNACCEPTABLE SERVICE

I joined Essential Med as of August 2017. When I joined a Network GP listing was sent to me which included my GP as a Network GP. A few weeks ago when I visited my GP, my GP informed me that he was not paid – when I queried this matter, I discovered that my GP was paid the out of network GP fee of R250 only and there are outstanding balances on each claim submitted. I have been back and forth with emails, telephone calls and using your online chat system to have this matter resolved – my emails are ignored and I get an attitude when communicating with your inefficient staff via telephone. The last communication that I received stated that my GP went off the network as of August 2017 – if this is the case then why wasn’t the GP listing updated accordingly before being sent to new clients? Surely, you have advance notifications of which GPs are going off and coming onto the Network? As a client, am I suppose this dream up this information? At no point in time since joining Essential Med was I sent any updated GP listing where I could check if my GP is still listed. The bottom line is that at the time I joined Essential Med, I was provided with information that stated my GP is a Network GP, therefore, I require my GP to be paid in full on all outstanding balances for all claims already submitted and proof of payment to be emailed to me as I need to give my GP feedback on this matter.

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Replies (3)
EssentialMED
EssentialMED's reply11 Jun 2018, 14:49
Official

Good day Rage1987,

Thank you for the enquiry. The out of network amount is R250 and therefore only that amount was paid.

The doctor did not call to confirm benefits as they are suppose to do. If they called they would have been informed that they are not part of the network.

The provider lists gets updated on a regular basis on our website and you are more than welcome to confirm on the list.

Kind regards,

Essential Med

RG
Reema G's update11 Jun 2018, 15:01
Reviewer Update
Essential Med - you have just proven your incompetence as it does not seem like you have taken the time to read and understand what the query is. WHICH PART OF - MY GP WAS LISTED ON THE GP LISTING THAT WAS SENT TO ME WHEN I JOINED ESSENTIAL MED DO YOU NOT UNDERSTAND??? IT IS NOT MY FAULT AS THE CLIENT THAT YOU ARE NOT DOING YOUR JOBS - THIS IS UNACCEPTABLE!!!
EssentialMED
EssentialMED's reply11 Jun 2018, 16:01
Official

Good day Rage1987,

Please be advised the practice cancelled their contract with Essential Med.

At the time of you signing up the practice was still on the network. They needed to follow procedure when it comes to benefit confirmation. They could also have advised you that they are not contracted with Essential Med when you went to consult with them.

Kind regards,