1 reviews | Active since Feb 2013
Genesis Hospital Plan Admin ***********
I joined Genesis Hospital Plan in July 2019. I comp**** with all the info disclosing past medical history for myself & beneficiary. I had a major medical scare on the 3 January 2020 and had to be admitted to hospital after a CT scan showed up abnormalities in my stomach - after being discharged I also had a G scope. A claim for all the bills relating to this incident were sent to Genesis and all were given a reference number. I received a letter from Genesis on the 10th January 2020 telling me that the doctors reports from the doctors I mentioned in my application for past medical history has not been received by the scheme and I have 7 days to get these certified reports or basically I will not be covered or cannot claim. I asked for the original emails sent to the doctors for the reports which I thought would have been actioned by the scheme when I joined , but instead received the copy emails to doctors which requests were only made when I needed to claim i.e. the 6 January 2020. What if I was in a coma or incapacitated and could not function but was given 7 days to respond (to get the reports myself) another factor is that all doctors go on leave from December and to my knowledge are only opening on the 14th January 2020. This all smacks of deceit and a way of not honouring/paying for a claim. It is disgusting and *********** to say the least - the biggest point for me is why only request reports now when I want to claim and not when I joined which I have no problem with as I gave my consent. Having been on Discovery and Momentum medical aids who conduct themselves most admirably this would not have happened.
We are so sorry that you are under the impression that there is intent not to honour or pay your claims. That is certainly not the case.
When a request is received for a reference number for a proposed procedure / treatment (or in retrospect your admission), the Scheme may routinely conduct a review, where medical reports are then requested from the relevant medical practitioners. During this process the allocation of a reference number is pended.
The Scheme will process the allocation of a reference number, as well as the subsequent claims following such admission and / treatment, as soon as the relevant information is received.
Although the Scheme makes every effort to conclude the review as speedily as possible, it is often out of our hands and we cannot release the reference until the review is concluded. It is for this reason that we requested your assistance in this matter. Thank you for your input - we will inform the relevant department managing this process to be cognisant of the time line where some of the doctors are still on leave.
Yours sincerely
GENESIS MEDICAL SCHEME
We are so sorry that you are under the impression that there is intent not to honour or pay your claims. That is certainly not the case.
When a request is received for a reference number for a proposed procedure / treatment (or in retrospect your admission), the Scheme may routinely conduct a review, where medical reports are then requested from the relevant medical practitioners. During this process the allocation of a reference number is pended.
The Scheme will process the allocation of a reference number, as well as the subsequent claims following such admission and / treatment, as soon as the relevant information is received.
Although the Scheme makes every effort to conclude the review as speedily as possible, it is often out of our hands and we cannot release the reference until the review is concluded. It is for this reason that we requested your assistance in this matter. Thank you for your input - we will inform the relevant department managing this process to be cognisant of the time line where some of the doctors are still on leave.
Yours sincerely
GENESIS MEDICAL SCHEME