KG
Khanyisile G
1 reviews | Active since Aug 2020
27 Aug 2020, 01:19
Feeling ****** and cheated on.
This scheme is bad in all angles..I am on a private option paying R3010 for myself and my kid. I have claims which were never paid.The recent claim was done in Feb 2020 till today the haven't reimbursed me..instead they focus on the Clicks unclear receipt with less money for medicine and rtelling me to go to Clicks.But the invoice from the pedetrician is clear and the funds that need to be paid back are not being paid. They play games up until you just feel you are taken for a ride. On another recent experience it has come to my attention when I took my son for dentist that their funds on dentist to cover for the whole year its only 10000. On this 10000 I have to pay for my son's dentist,hospital and Anesthesia doctor too.So this useless R10000.00 only covers the dentist doctor only. This scheme is just day time to *******. I hope something will be done in investigating their conduct.
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Replies (2)
Genesis Medical Scheme's replyOfficial
27 Aug 2020, 10:17Dear Khanyisile
Thank you for your enquiry. We will investigate your feedback and revert once we have all the information.
Yours sincerely
THE GENESIS TEAM
Thank you for your enquiry. We will investigate your feedback and revert once we have all the information.
Yours sincerely
THE GENESIS TEAM
Genesis Medical Scheme's reply27 Aug 2020, 10:17
Official
Dear Khanyisile
Thank you for your enquiry. We will investigate your feedback and revert once we have all the information.
Yours sincerely
THE GENESIS TEAM
Thank you for your enquiry. We will investigate your feedback and revert once we have all the information.
Yours sincerely
THE GENESIS TEAM
Genesis Medical Scheme's replyOfficial
27 Aug 2020, 18:35 Dear Khanyisile
We are really sorry that you feel you have been taken for a ride, as it is most certainly not our intention to take you, or any other member for that matter, for a ride.
There have been various emails between the Scheme and yourself and we have also on numerous occasions tried to call you. We were unfortunately never able to get hold of you, but have always followed up with an email, informing you that we tried calling you and also requesting alternative contact details.
The long and the short of the scenario is that the Clicks claim, as well as Dr de Campus’s claim, were rejected in February 2020, as these claims / receipts were illegible. Although the receipt from Dr de Campus was legible, we needed the detailed claim with practice details, a valid ICD-10 code(s), the amount charged per tariff code and the patient particulars. You were informed of these requirements in February, as well as in July and August when you followed up on these claims.
Although the onus is always on a member to submit valid and legible claims to the Scheme, we have contacted Dr de Campus’s rooms and requested a detailed claim. This was received this afternoon and has gone through for processing. The Clicks claim can unfortunately not be processed unless we receive a clear copy. Kindly obtain a clear copy and submit to the scheme for processing.
Regarding your dental query on 21 August, please note that we contacted you for assistance / feedback, but could again not reach you. We then followed up with another email, requesting an alternative contact number. We have however confirmed that our benefit for basic dentistry is limited to R10,000 per beneficiary per annum for the surgical removal of bony impacted wisdom teeth, or for child beneficiaries younger than 9 years for extractions and fillings when done in a hospital or day clinic.
We also want to encourage you to provide us with an alternative contact number where we can reach you (please use the general email address for any concerns/queries you may have). Direct communication always goes a long way in clarifying queries and concerns.
We trust that you will find this in order. Yours sincerely
GENESIS MEDICAL SCHEME
We are really sorry that you feel you have been taken for a ride, as it is most certainly not our intention to take you, or any other member for that matter, for a ride.
There have been various emails between the Scheme and yourself and we have also on numerous occasions tried to call you. We were unfortunately never able to get hold of you, but have always followed up with an email, informing you that we tried calling you and also requesting alternative contact details.
The long and the short of the scenario is that the Clicks claim, as well as Dr de Campus’s claim, were rejected in February 2020, as these claims / receipts were illegible. Although the receipt from Dr de Campus was legible, we needed the detailed claim with practice details, a valid ICD-10 code(s), the amount charged per tariff code and the patient particulars. You were informed of these requirements in February, as well as in July and August when you followed up on these claims.
Although the onus is always on a member to submit valid and legible claims to the Scheme, we have contacted Dr de Campus’s rooms and requested a detailed claim. This was received this afternoon and has gone through for processing. The Clicks claim can unfortunately not be processed unless we receive a clear copy. Kindly obtain a clear copy and submit to the scheme for processing.
Regarding your dental query on 21 August, please note that we contacted you for assistance / feedback, but could again not reach you. We then followed up with another email, requesting an alternative contact number. We have however confirmed that our benefit for basic dentistry is limited to R10,000 per beneficiary per annum for the surgical removal of bony impacted wisdom teeth, or for child beneficiaries younger than 9 years for extractions and fillings when done in a hospital or day clinic.
We also want to encourage you to provide us with an alternative contact number where we can reach you (please use the general email address for any concerns/queries you may have). Direct communication always goes a long way in clarifying queries and concerns.
We trust that you will find this in order. Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply27 Aug 2020, 18:35
Official
Dear Khanyisile
We are really sorry that you feel you have been taken for a ride, as it is most certainly not our intention to take you, or any other member for that matter, for a ride.
There have been various emails between the Scheme and yourself and we have also on numerous occasions tried to call you. We were unfortunately never able to get hold of you, but have always followed up with an email, informing you that we tried calling you and also requesting alternative contact details.
The long and the short of the scenario is that the Clicks claim, as well as Dr de Campus’s claim, were rejected in February 2020, as these claims / receipts were illegible. Although the receipt from Dr de Campus was legible, we needed the detailed claim with practice details, a valid ICD-10 code(s), the amount charged per tariff code and the patient particulars. You were informed of these requirements in February, as well as in July and August when you followed up on these claims.
Although the onus is always on a member to submit valid and legible claims to the Scheme, we have contacted Dr de Campus’s rooms and requested a detailed claim. This was received this afternoon and has gone through for processing. The Clicks claim can unfortunately not be processed unless we receive a clear copy. Kindly obtain a clear copy and submit to the scheme for processing.
Regarding your dental query on 21 August, please note that we contacted you for assistance / feedback, but could again not reach you. We then followed up with another email, requesting an alternative contact number. We have however confirmed that our benefit for basic dentistry is limited to R10,000 per beneficiary per annum for the surgical removal of bony impacted wisdom teeth, or for child beneficiaries younger than 9 years for extractions and fillings when done in a hospital or day clinic.
We also want to encourage you to provide us with an alternative contact number where we can reach you (please use the general email address for any concerns/queries you may have). Direct communication always goes a long way in clarifying queries and concerns.
We trust that you will find this in order. Yours sincerely
GENESIS MEDICAL SCHEME
We are really sorry that you feel you have been taken for a ride, as it is most certainly not our intention to take you, or any other member for that matter, for a ride.
There have been various emails between the Scheme and yourself and we have also on numerous occasions tried to call you. We were unfortunately never able to get hold of you, but have always followed up with an email, informing you that we tried calling you and also requesting alternative contact details.
The long and the short of the scenario is that the Clicks claim, as well as Dr de Campus’s claim, were rejected in February 2020, as these claims / receipts were illegible. Although the receipt from Dr de Campus was legible, we needed the detailed claim with practice details, a valid ICD-10 code(s), the amount charged per tariff code and the patient particulars. You were informed of these requirements in February, as well as in July and August when you followed up on these claims.
Although the onus is always on a member to submit valid and legible claims to the Scheme, we have contacted Dr de Campus’s rooms and requested a detailed claim. This was received this afternoon and has gone through for processing. The Clicks claim can unfortunately not be processed unless we receive a clear copy. Kindly obtain a clear copy and submit to the scheme for processing.
Regarding your dental query on 21 August, please note that we contacted you for assistance / feedback, but could again not reach you. We then followed up with another email, requesting an alternative contact number. We have however confirmed that our benefit for basic dentistry is limited to R10,000 per beneficiary per annum for the surgical removal of bony impacted wisdom teeth, or for child beneficiaries younger than 9 years for extractions and fillings when done in a hospital or day clinic.
We also want to encourage you to provide us with an alternative contact number where we can reach you (please use the general email address for any concerns/queries you may have). Direct communication always goes a long way in clarifying queries and concerns.
We trust that you will find this in order. Yours sincerely
GENESIS MEDICAL SCHEME