TB
Thinus B
1 reviews | Active since Oct 2010
08 Nov 2023, 11:01
Claims process a disaster
No wonder most of the providers want upfront payment when your medical aid is with Genesis. Their claims takes forever to be processed, when it eventually gets processed with Icd 10 code invalid and doesn't get paid out. No explanation whatsoever and don't see anything wrong with the invoice submitted.
Helpful (0)
Replies (3)0
Replies (3)
Genesis Medical Scheme's replyOfficial
08 Nov 2023, 13:06Dear Mr Bierman
The Scheme shall, where an account has been rendered, pay any benefit that is due to a member, either to the member or the service provider, within 30 days of receipt of the claim.
Understandably, where information (such as an ICD-10 code) is outstanding / incorrect, the Scheme will not process such a claim(s).
Should an account not be paid, it will always reflect on your monthly claims statement, with a reason code provided and an action required from the member.
In order for the Scheme to reassess and pay your outstanding claim(s), kindly contact the Scheme for further guidance, or submit a correct invoice to us.
Yours sincerely
GENESIS MEDICAL SCHEME
The Scheme shall, where an account has been rendered, pay any benefit that is due to a member, either to the member or the service provider, within 30 days of receipt of the claim.
Understandably, where information (such as an ICD-10 code) is outstanding / incorrect, the Scheme will not process such a claim(s).
Should an account not be paid, it will always reflect on your monthly claims statement, with a reason code provided and an action required from the member.
In order for the Scheme to reassess and pay your outstanding claim(s), kindly contact the Scheme for further guidance, or submit a correct invoice to us.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply08 Nov 2023, 13:06
Official
Dear Mr Bierman
The Scheme shall, where an account has been rendered, pay any benefit that is due to a member, either to the member or the service provider, within 30 days of receipt of the claim.
Understandably, where information (such as an ICD-10 code) is outstanding / incorrect, the Scheme will not process such a claim(s).
Should an account not be paid, it will always reflect on your monthly claims statement, with a reason code provided and an action required from the member.
In order for the Scheme to reassess and pay your outstanding claim(s), kindly contact the Scheme for further guidance, or submit a correct invoice to us.
Yours sincerely
GENESIS MEDICAL SCHEME
The Scheme shall, where an account has been rendered, pay any benefit that is due to a member, either to the member or the service provider, within 30 days of receipt of the claim.
Understandably, where information (such as an ICD-10 code) is outstanding / incorrect, the Scheme will not process such a claim(s).
Should an account not be paid, it will always reflect on your monthly claims statement, with a reason code provided and an action required from the member.
In order for the Scheme to reassess and pay your outstanding claim(s), kindly contact the Scheme for further guidance, or submit a correct invoice to us.
Yours sincerely
GENESIS MEDICAL SCHEME
TB
Thinus B's updateReviewer Update
07 Dec 2023, 10:14Well the claim was resubmitted on the 8th of November, still no refund and below response from customer care, so there goes your statement of 30 days out the window.
With reference to your query received.
Kindly be advised that your claim for service date 06/09/2023 has been received and processed as a reimbur*****t to you as the member with our next claims run dated 29/12/2023.
It is important to note that the scheme has one payment run per month, which scheduled for the last working day of the month.
A detailed remittance will be sent to the listed email address thereafter.
Please note that in terms of the Scheme Rules you are required to give the Scheme not less than one months' notice of cancellation.
With reference to your query received.
Kindly be advised that your claim for service date 06/09/2023 has been received and processed as a reimbur*****t to you as the member with our next claims run dated 29/12/2023.
It is important to note that the scheme has one payment run per month, which scheduled for the last working day of the month.
A detailed remittance will be sent to the listed email address thereafter.
Please note that in terms of the Scheme Rules you are required to give the Scheme not less than one months' notice of cancellation.
TB
Thinus B's update07 Dec 2023, 10:14
Reviewer Update
Well the claim was resubmitted on the 8th of November, still no refund and below response from customer care, so there goes your statement of 30 days out the window.
With reference to your query received.
Kindly be advised that your claim for service date 06/09/2023 has been received and processed as a reimbur*****t to you as the member with our next claims run dated 29/12/2023.
It is important to note that the scheme has one payment run per month, which scheduled for the last working day of the month.
A detailed remittance will be sent to the listed email address thereafter.
Please note that in terms of the Scheme Rules you are required to give the Scheme not less than one months' notice of cancellation.
With reference to your query received.
Kindly be advised that your claim for service date 06/09/2023 has been received and processed as a reimbur*****t to you as the member with our next claims run dated 29/12/2023.
It is important to note that the scheme has one payment run per month, which scheduled for the last working day of the month.
A detailed remittance will be sent to the listed email address thereafter.
Please note that in terms of the Scheme Rules you are required to give the Scheme not less than one months' notice of cancellation.
Genesis Medical Scheme's replyOfficial
07 Dec 2023, 10:40Dear Mr Bierman
The claim was not paid within 30 days of receipt of the claim, because your contributions for November were not paid and your membership was suspended.
Now that the Scheme has received your outstanding contribution, your claim will be settled as per the communication that you received from us.
Yours sincerely
GENESIS MEDICAL SCHEME
The claim was not paid within 30 days of receipt of the claim, because your contributions for November were not paid and your membership was suspended.
Now that the Scheme has received your outstanding contribution, your claim will be settled as per the communication that you received from us.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply07 Dec 2023, 10:40
Official
Dear Mr Bierman
The claim was not paid within 30 days of receipt of the claim, because your contributions for November were not paid and your membership was suspended.
Now that the Scheme has received your outstanding contribution, your claim will be settled as per the communication that you received from us.
Yours sincerely
GENESIS MEDICAL SCHEME
The claim was not paid within 30 days of receipt of the claim, because your contributions for November were not paid and your membership was suspended.
Now that the Scheme has received your outstanding contribution, your claim will be settled as per the communication that you received from us.
Yours sincerely
GENESIS MEDICAL SCHEME