MB
Mark B
1 reviews | Active since Oct 2018
01 Jun 2022, 08:03
Genesis medical scheme worst service received ever!
Worst medical aid i have ever belonged to. Was on a hospital plan and had a medical emergency which was also because of a PMB condition and they flat out refused to pay the emergency room account because i was not admitted. That being said i used their preferred ambulance for transportation to hospital for the same medical emergency and they also refused to pay this account. If i could give them 0 stars in the rating i would. I might as well not have had cover.
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Genesis Medical Scheme's replyOfficial
01 Jun 2022, 12:32Dear Mark
We will look into this complaint and revert to you shortly.
Yours sincerely
GENESIS MEDICAL SCHEME
We will look into this complaint and revert to you shortly.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply01 Jun 2022, 12:32
Official
Dear Mark
We will look into this complaint and revert to you shortly.
Yours sincerely
GENESIS MEDICAL SCHEME
We will look into this complaint and revert to you shortly.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's replyOfficial
02 Jun 2022, 08:05 Dear Mark
We have investigated the matter and would like to provide you with the following feedback.
Although your visit to the emergency room may have been related to an existing PMB condition, there was not a “medical emergency”. A medical emergency in legal terms (in other words, to qualify for PMB funding benefits) is defined as the sudden and, at the time unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment of bodily functions, or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy.
According to our records, there was no clinical indication of a life-threatening condition, or that you received any treatment whatsoever on that day. Please also bear in mind that diagnostic tests are not “treatment”. Accordingly, and given the information available to us, the Scheme did not fund your claims as it relate to normal out-of-hospital benefits that were not available on your selected benefit option.
If, however, you did receive treatment on that day, then please contact the Scheme and provide us with additional information. We will gladly reassess the claims.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply02 Jun 2022, 08:05
Official
Dear Mark
We have investigated the matter and would like to provide you with the following feedback.
Although your visit to the emergency room may have been related to an existing PMB condition, there was not a “medical emergency”. A medical emergency in legal terms (in other words, to qualify for PMB funding benefits) is defined as the sudden and, at the time unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment of bodily functions, or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy.
According to our records, there was no clinical indication of a life-threatening condition, or that you received any treatment whatsoever on that day. Please also bear in mind that diagnostic tests are not “treatment”. Accordingly, and given the information available to us, the Scheme did not fund your claims as it relate to normal out-of-hospital benefits that were not available on your selected benefit option.
If, however, you did receive treatment on that day, then please contact the Scheme and provide us with additional information. We will gladly reassess the claims.
Yours sincerely
GENESIS MEDICAL SCHEME