1 reviews | Active since Mar 2015
GapRisk - Medical Gap Cover insurer - *****ulent activity should be investigated!
GapRisk is a Gap Cover insurer who collects money monthly from their clients, but when claims are admitted, they go to extreme lengths to prevent paying out shortfalls from Medical cover. I have submitted numerous document, statement, proof of payment and more to support my claims. Even after sending through these document, they are still refusing to cover my shortfall expenses to the attending doctor or hospital. They have even gone so far as to request that I get a comprehensive doctor report. Just another company milking us for all out money, util they are required. The GapRisk agent won't even contact my medical aid, hospital or doctor to request everything they need! Why are they in business then. They sit back, request all sorts of impossible documentation. They do this in the hope of customers getting tired of trying. Even if customers cancel their subscription or debit orders, they win all the way, as they have already collected all my payment and simply moves on to the next victim! I'm highly disgusted, irritated, also very concerned for other customers who are heading for the same disappointment!
Thank you for your feedback.
Our claims process is simple. We require the following documents in order to ascertain validity of claim (as any responsible business would do).
*Specialist statement (PMB codes used for diagnosis)
*Hospital account (in order to assure that procedure was done in-hospital / according to ICD codes specified)
*Claims form (what service is being claimed for)
*Medical aid statement indicating payment from the medical scheme (we cannot act in isolation - we can only supplement qualifying claims payment from the medical aid)
*Additional Reports if diagnosis as PMB is suspected (medical aid is responsible for providing cover - GapCover is a short-term insurance product, not governed by the same rules as a medical scheme, thus cannot make supplementary payments for PMB claims) - this was not provided, and after numerous follow-ups, your claim was rejected.
*We are not allowed to act on your behalf by calling your medical aid, doctors, or hospitals, - however, your broker can act on your behalf.
*We do not require proof of payment from the client
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.
Kind regards,
The GapRisk / GapCover Team
Thank you for your feedback.
Our claims process is simple. We require the following documents in order to ascertain validity of claim (as any responsible business would do).
*Specialist statement (PMB codes used for diagnosis)
*Hospital account (in order to assure that procedure was done in-hospital / according to ICD codes specified)
*Claims form (what service is being claimed for)
*Medical aid statement indicating payment from the medical scheme (we cannot act in isolation - we can only supplement qualifying claims payment from the medical aid)
*Additional Reports if diagnosis as PMB is suspected (medical aid is responsible for providing cover - GapCover is a short-term insurance product, not governed by the same rules as a medical scheme, thus cannot make supplementary payments for PMB claims) - this was not provided, and after numerous follow-ups, your claim was rejected.
*We are not allowed to act on your behalf by calling your medical aid, doctors, or hospitals, - however, your broker can act on your behalf.
*We do not require proof of payment from the client
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.
Kind regards,
The GapRisk / GapCover Team