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Wikus C

1 reviews | Active since Jul 2020

02 Jul 2020, 09:39

Poor service

My son went in to the dentist on the 17th of June 2020 and a week prior my wife confirmed with the scheme that we are approved for the procedure. We should just sen the proof of payment and we will receive our reimbur*****t.

My wife now needs to get an apendectomy which the surgeon has stated to the medical scheme is chronic. This was sent to Genesis on Monday the 29th of June. Genesis contacted me on Tuesday afternoon to inform me my wife's surgery for thursday might not happen and that they are now witholding the funds for my son's dental procedure. This is because they need to do a family history on my whole family before anything can take place!

What does my son's dental procedure that was already approved by Genesis have to do with my wife's surgery that needs to happen today? Nothing, they tell me it is just their process. I am certain if the dental was approved and after the fact they withold my reimbur*****t they are reneging on their contract with me!

My wife was booked for 11am today Thursday the 2nd of July which means Genesis was informed almost exactly 72hours prior to surgery. It is now 09:35am and they have ignored my emails since yesterday the 1st of July. I have sent 3 emails regarding my wife's surgery and still I have not heard back anything!

Genesis reconsider your business model because from the hellopeter reviews I can tell most every client that has taken the time to send a review is unhappy!

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Replies (2)
Genesis Medical Scheme
Genesis Medical Scheme's reply02 Jul 2020, 12:24
Official
Good morning Wikus

We have just followed up with our Clinical Department and as you already know, the Scheme has, despite the fact that the medical history review (MHR) process has not been finalised, released a hospital admission reference number for your wife’s procedure this afternoon, in good faith.  

We trust that everything will go well with her procedure and that she will have a speedy recovery.

The Scheme may conduct a routine MHR for treatment that requires hospitalisation, or other / further medical treatment, especially if a request for such treatment is requested shortly after a member joins the Scheme and when the requested treatment is related to a condition(s) that were not disclosed on the member’s application form.

Under these circumstances all claims (i.e. your dental claim) will be suspended until such time as the MHR has been completed.  

We again followed up with Madeleen at Dr Loots’s rooms, as the clinical input we received from him, was incomplete.  We will however continue to follow up.  As soon as the relevant information has been received, we will be in a position to complete the MHR process.  If everything is in order, we will process your dental claim immediately.  

Yours sincerely

GENESIS MEDICAL SCHEME

WC
Wikus C's update02 Jul 2020, 15:58
Reviewer Update
Dear Genesis team

Yes only after i wrote the review on hellopeter did I get the appropriate response from you and the hospital admission was approved.

However this all could have been avoided if you had just responded to my numerous emails. Thank you for having people who work there like Tracy, she actually listened to me during our conversation.

Thank you for acting in good faith and I sincerely hope that you can complete you MHR and obtain all the required information in a timely and appropriate manner.

Regards
Wikus Ceronie