JJ
Jennifer J

1 reviews | Active since Aug 2022

19 Sept 2024, 17:26

Don't fall for the **** of GAPRISK. THEY WILL NOT PAY YOUR HOSPITAL OR MEDICAL BILLS.

My elderly father signed up with gaprisk in 2021. He has never been ill. Until this year March after the loss of my Mom (his wife of 64 years) He suffered a CVA / STROKE. As one can imagine there were numerous bills, co- payments that his medical aid did not cover. I paid all the co- payments out of my own pocket. Once he had slightly recovered following arterial surgery and insurmountable bills I tried to claim from his gaprisk cover. I was met with a gigantic list of requirements. Drs account. MRI report Xray report Medical aid accounts and proof of payments. Medical diagnosis. Proof of payments by myself. Fill out a claim form for every single Dr. involved including their invoices, practice numbers. Days of consultation. Date of xray. Date of surgery. Medical codes. I had to fill in forms to claim on his behalf. ( 3 times to confirm that he gave permission for me to access the records) Numerous phone calls. Unnecessary stress and time.

After numerous calls, emails and no success with payment my father gave me his permission to resign from gaprisk.

It is/was a useless exercise. I had neither the time nor patience to do all of this paperwork. So GapRisk, you scored R318 / per month since 2021 for absolutely no assistance. You are a RIPOFF. Approximately R4000 rand a year wasted. You make claiming so difficult, time consuming and repetitive and to this day your have still not paid a single claim.

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Replies (1)
GapRisk Administrators
GapRisk Administrators's reply17 Oct 2024, 12:21
Official
Good day, Ms Hackney Jordaan
 
 Thank you for your feedback. Firstly, we wish to extend our sincerest condolences with your mother’s passing and wish you both well.
 
 In explanation of your concern, the following:
 Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. Your policy documents clearly stipulate that GapCover does NOT cover PMB's (certain Stroke conditions incl). Cover is provided by your medical scheme. Please remember that GapCover is a short-term insurance product and not governed by the same rules as that of a medical scheme. In order to determine whether the condition was PMB, we requested additional reports, which was not provided. 
 
We empathise with the difficult circumstances you and your father experienced with the passing of your mother. However, we cannot act against our prescribed rules and governance. As usual, we advise our clients to please carefully read your policy documents. Also, we offer a pre-assessment service where you can request a pre-assessment of your claim prior to your procedure. 
 
Please feel free to contact us should you require further feedback to your concerns. 

Wishing you both well.
 
Kind regards,
The GapRisk / GapCover Team