YG
Yoosha G
1 reviews | Active since Dec 2017
08 Apr 2022, 22:18
Pathetic excuse for a medical aid company
Genesis medical aid is the worst medical aid I've ever been with. They don't pay claims like they say. They said I get R10 000 for removal of impacted wisdoms. They only paid me out R2300. This is absolutely ridiculous. I had to pay the balance.
You pay high rates every month just to be turned down claim time.
I regret joining Genesis. There reviews are just getting worse and worse. I wouldn't recommend them to anyone
I am now looking at other options to get away from these guys. You pay alot pf money every month to be turned down when you claim
When you get sick, you worry more about having to fight with Genesis to pay your claims then actually being sick.
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Genesis Medical Scheme's replyOfficial
11 Apr 2022, 15:39Dear Yoosha
Thank you for taking our call earlier today.
As we explained to you, one of the specialists who was involved in your treatment submitted an incorrect claim to Genesis. Consequently, the claim was rejected. This was no fault of the Scheme. An amended claim has subsequently been received and will be processed and paid with the next payment run.
We also mentioned to you that the dental benefit applicable to your procedure is not a stated benefit of R10,000. The benefit is limited to the lower of cost or R10,000 and paid at the Scheme Tariff, which is 100%. In your instance, some of your specialists’ claims ranged between 100% and 547% of the Scheme Tariff.
There is no legal framework with regard to doctors’ fees in South Africa - they may charge whatever they want. Unfortunately any / all rates above 100% of Scheme Tariff will be for the member’s account, unless he/she has gap cover, and/or he/she can negotiate with his/her doctor to amend their billing to be in line with what his / her medical scheme will cover. We encourage you to speak to them.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply11 Apr 2022, 15:39
Official
Dear Yoosha
Thank you for taking our call earlier today.
As we explained to you, one of the specialists who was involved in your treatment submitted an incorrect claim to Genesis. Consequently, the claim was rejected. This was no fault of the Scheme. An amended claim has subsequently been received and will be processed and paid with the next payment run.
We also mentioned to you that the dental benefit applicable to your procedure is not a stated benefit of R10,000. The benefit is limited to the lower of cost or R10,000 and paid at the Scheme Tariff, which is 100%. In your instance, some of your specialists’ claims ranged between 100% and 547% of the Scheme Tariff.
There is no legal framework with regard to doctors’ fees in South Africa - they may charge whatever they want. Unfortunately any / all rates above 100% of Scheme Tariff will be for the member’s account, unless he/she has gap cover, and/or he/she can negotiate with his/her doctor to amend their billing to be in line with what his / her medical scheme will cover. We encourage you to speak to them.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME