Looking to turn a 1-star into a 5-star review

When we bought TRA Gap Cover, we bought into the “dream” that they sell. The dream and the promise that “The gap is covered in instances where there is a shortfall between what service providers charge and what your medical aid scheme will cover for in-hospital expenses.

We bought Gap Cover for peace of mind. Unfortunately peace of mind is not what we are experiencing. We as clients are stuck between the unholy triangle that is the Medical Aid, Specialists and Gap Cover. You are rudely awakened from the dream at claims stage and this is where the nightmare begins.

It is ONLY at CLAIMS STAGE that you suddenly hear from the consultant that the specialists’ ENTIRE BILL is rejected because the medical aid rejected ONE CODE, of an authorized hospital event, whilst they paid on all the other line items!! Nowhere does it say, nor is it ever mentioned by any of your consultants that TRA will reject an entire account, if A SINGLE LINE ITEM is rejected by the medical aid. We have looked at your literature and online website marketing….no mention! What we do find online is the promise that shortfalls will be paid. This is the promise we bought into. We chose Vital Cover Plus as well on the recommendation of the selling agent. Why is it that our claim is not being paid, like Ezra’s (per your TRA website advertising)? Why does Ezra get to realize the dream and we don’t? What we were sold is “as long as the medical aid pays a portion, we will cover the rest…up to 700% worth, no fuss!” This is not what is happening. If this is not true then your advertising is deliberately misleading or your people are not adequately trained. False advertising? I prefer to think it’s a training issue. Please help in resolving our claim. The sad reality is, with the medical aid we know they won’t pay the specialist invoice in full. That is why we take out gap cover – with a maximum of R165 000 per annum per insured person @ 700%.... for PEACE OF MIND, as advertised. We bought TRA Gap Cover for this very reason. Please assist in resolving our claims so that we too don’t need to stress! Help TRA Gap Cover! we bought you for a reason! We have claims in your system since 17 December 2020 that have yet to be resolved. "Total Risk Administrators has Specialist staff with years of insurance, clinical and healthcare administration experience, so there’s really no need to stress! This GAP is indeed Covered."