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yolanda M
1 reviews | Active since Apr 2021
10 Feb 2023, 11:11
Worst Med... Insurance Poor Service
The worst medical insurance to date... my son was sick and needed to be admitted immediately, guess what i dealt with authorization from 9am till 6 pm and was only admitted at 8pm.
The authorization approved R60 000 for that hospital stay, and luckily for a week we were only charged R35 000 and these people only made a payment of R24 000, I'VE BEEN EMAILING NONE STOP BUT NO ONE BOTHERS TO RESPOND. Now the hospital is threating legal action. i called but still no help or any feedback. i emailed afro centric they confirmed that 60k was the approved amount and should check with essential med but as usual no one from essential med is willing to answer me.
no wonder some hospitals turn us back with this med insurance, all they know is to send us SMS's claiming non payment when payments went through then they blame their lousy system.
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Replies (2)
EssentialMED's replyOfficial
19 Feb 2023, 09:24Hi Yolanda,
Trust you are doing well.Thank you for bringing this matter to our attention.When we received the call for admission the hospital requested admission to ICU and the GOP was issued according to your policy benefits.However when we received the account from Life Cosmos they stated that your son was not admitted to ICU but instead to the normal pediatric ward for 5 days. The account received was R35 272.72 whereby we paid the amount of R24 500 according to your benefits on your policy.The benefit level on your policy for illness admissions is level 3 and payment was calculated as follow: Day 1 - R10 000Day 2 - R6 500Day 3 - R5 000Day 4 - R1 500Day 5 - R1 500Total benefit for admission R24 500.00 I trust this will provide more clarity on the matter. Should you need any further assistance please do not hesitate to contact us. Kind Regards,
Trust you are doing well.Thank you for bringing this matter to our attention.When we received the call for admission the hospital requested admission to ICU and the GOP was issued according to your policy benefits.However when we received the account from Life Cosmos they stated that your son was not admitted to ICU but instead to the normal pediatric ward for 5 days. The account received was R35 272.72 whereby we paid the amount of R24 500 according to your benefits on your policy.The benefit level on your policy for illness admissions is level 3 and payment was calculated as follow: Day 1 - R10 000Day 2 - R6 500Day 3 - R5 000Day 4 - R1 500Day 5 - R1 500Total benefit for admission R24 500.00 I trust this will provide more clarity on the matter. Should you need any further assistance please do not hesitate to contact us. Kind Regards,
EssentialMED's reply19 Feb 2023, 09:24
Official
Hi Yolanda,
Trust you are doing well.Thank you for bringing this matter to our attention.When we received the call for admission the hospital requested admission to ICU and the GOP was issued according to your policy benefits.However when we received the account from Life Cosmos they stated that your son was not admitted to ICU but instead to the normal pediatric ward for 5 days. The account received was R35 272.72 whereby we paid the amount of R24 500 according to your benefits on your policy.The benefit level on your policy for illness admissions is level 3 and payment was calculated as follow: Day 1 - R10 000Day 2 - R6 500Day 3 - R5 000Day 4 - R1 500Day 5 - R1 500Total benefit for admission R24 500.00 I trust this will provide more clarity on the matter. Should you need any further assistance please do not hesitate to contact us. Kind Regards,
Trust you are doing well.Thank you for bringing this matter to our attention.When we received the call for admission the hospital requested admission to ICU and the GOP was issued according to your policy benefits.However when we received the account from Life Cosmos they stated that your son was not admitted to ICU but instead to the normal pediatric ward for 5 days. The account received was R35 272.72 whereby we paid the amount of R24 500 according to your benefits on your policy.The benefit level on your policy for illness admissions is level 3 and payment was calculated as follow: Day 1 - R10 000Day 2 - R6 500Day 3 - R5 000Day 4 - R1 500Day 5 - R1 500Total benefit for admission R24 500.00 I trust this will provide more clarity on the matter. Should you need any further assistance please do not hesitate to contact us. Kind Regards,
EssentialMED's replyOfficial
06 Mar 2023, 11:38Thank you for bringing this concerning matter to our attention. We have looked into your concerns raised and would like to advise as follow: We received a request for hospital admission and alternative documentation was requested from you in order for us to provide cover. The documentation requested was received on the 16th of February and one of our authorization consultants contacted you to explain the benefit amount to you. The authorization consultant have emailed you a cession form that needs to be signed in order for us to issue the authorization number and document. Kindly please be advise we are still awaiting the signed form in order to issue the GOP. Should you need any further assistance please do not hesitate to contact us. Kind Regards
EssentialMED's reply06 Mar 2023, 11:38
Official
Thank you for bringing this concerning matter to our attention. We have looked into your concerns raised and would like to advise as follow: We received a request for hospital admission and alternative documentation was requested from you in order for us to provide cover. The documentation requested was received on the 16th of February and one of our authorization consultants contacted you to explain the benefit amount to you. The authorization consultant have emailed you a cession form that needs to be signed in order for us to issue the authorization number and document. Kindly please be advise we are still awaiting the signed form in order to issue the GOP. Should you need any further assistance please do not hesitate to contact us. Kind Regards