Disappointed by Partial Hospital Plan Payout – Request for Review

Update – 9 January 2026

Thank you for the earlier engagement.

Following my email of 5 January 2026 to FNB Life, I have not yet received any formal feedback on my dispute. The claim status on the FNB app indicates “assessment completed – 5 January,” but no written outcome or confirmation has been provided.

For context, I supp**** all supporting documents, including hospital invoices, ICD-10 codes, and blood results, and also explained in writing that the full hospital file and formal specialist motivations are not readily available without significant cost or management approval.

I would appreciate written confirmation of:
The outcome of the reassessment; or
Whether my dispute is still under review.

I remain hopeful for a fair and transparent resolution, consistent with the efficient service I have previously received from FNB Life.

Thank you for your attention to this matter.

Clarification of Timeline and Request for Status....

I would like to provide a clarification and further update for accuracy.....

My initial complaint was posted on 23 December 2025. The outcome letter explaining the partial payment of my hospital claim was only received on 31 December 2025, despite earlier indication that it would be sent.

I submitted my formal dispute on 01 January 2026, and on 05 January 2026 I followed up in writing after the claim status on the FNB app reflected “assessment completed.” In that email, I responded in detail to the request for additional documentation and explained the challenges and costs associated with obtaining full hospital files and formal specialist motivation letters.

Since my follow-up on 05 January, I have not received any verbal communicatio, written feedback, acknowledgment, or guidance, despite having comp**** fully and engaged in good faith.

I fully appreciate that this period includes public holidays, and I have been patient throughout. However, I am now seeking clarity on the current status of my dispute and an expected timeframe for resolution, as the absence of communication makes it difficult to understand how to proceed.

My preference remains to resolve this matter directly with FNB Life. That said, continued lack of response may meet the criteria for referral to the relevant Ombudsman, due to absence of communication following a formal dispute.

I remain hopeful that this can be resolved fairly and transparently without the need for external escalation.

Thank you for your attention.

Dear Claims Department,

Trust you are well.

Further to my email dated 13 January 2026, in which I submitted the documents currently available to me for interim dispute assessment, I have not yet received any written feedback.

However, the FNB app status now reflects “Additional documentation required”, without specifying what documents are outstanding.

Kindly confirm in writing exactly which additional documents are required, as well as whether these must be obtained from Johannesburg Surgical Hospital or the treating doctor/specialist, I am not willing to outlay ridiculous amounts.

For reference, the documents already submitted include:

1. Completed Health Claim Form
2. Comprehensive hospital invoice (ICD-10 codes and medication administered)
3. Blood and pathology results (including confirmed infection and INR results)
4. Supporting screenshots from the Lancet laboratory portal where PDF downloads were not available

I would also like to note that this matter has been ongoing since my initial enquiry and submission on 23 December 2025, and I believe sufficient time has passed for clarity on the way forward and for the dispute to be assessed using the comprehensive information already provided.

If the assessors are unable to assess the dispute based on the information submitted to date, I respectfully request that a formal written outcome (approval or rejection) be issued so that I may proceed with the appropriate next steps, including referral to the relevant Ombudsman, if required.

My preference remains to resolve this matter directly with FNB Life; however, I require clear communication and finalisation of the dispute.

I would appreciate your urgent guidance.

Kind regards,

With reference to logging my complaint under reference ***NF.

Unfortunately, I have received no further feedback or response from either the claims team or the HelloPeter complaints team, despite multiple follow-ups.

I have sent several emails, submitted supporting documentation, and posted multiple updates on this thread in good faith, but communication remains extremely poor.

At this stage, I am not only disputing the claim outcome, but also the ongoing lack of communication and failure to provide clear guidance on outstanding requirements.

The app reflects “additional documentation required” without stating what is required, which makes it impossible to move the matter forward.

FNB’s slogan “How can we help you?” feels meaningless when customers are unable to obtain basic feedback or finalisation.

If I do not receive a written update with clear next steps and a timeframe for finalisation by COB today, I will proceed with referral to the relevant Ombudsman, together with the full correspondence trail.

I would still prefer to resolve this directly with FNB.

Final Update – Matter Resolved....

I would like to thank FNB Life for finally resolving this matter & paying the outstanding balance of 5 hospital days.

I appreciate that the claim was reconsidered and that a fair outcome was reached.

I would, however, like to share something from a patient’s perspective.....

We do not like hospitals. Admission is never a convenience or a choice. For many of us living with autoimmune disease, hospital is the last resort....a place we go only when our bodies have reached a point we can no longer manage at home.

I, for one, would never be admitted for “pain management” unless the situation became extreme & medically necessary. Autoimmune conditions are not all mild or straightforward; some of us are severe & complicated cases, with infections, flares & risks that require close inpatient care.

Hospital stays come with pain, trauma, anxiety & loss....we lose hours, days, sometimes weeks or months of our lives. Families are disrupted, work is paused & recovery is hard.... Nobody chooses this.

I hope that, going forward, claims involving autoimmune & complex medical conditions will be assessed with a deeper understanding of these realities & with clearer communication so that patients are not left feeling dismissed during an already vulnerable time.

Thank you to the team who ultimately assisted in bringing this matter to conclusion.