BC
Brogan C
1 reviews | Active since Feb 2019
21 Mar 2022, 08:05
Spiteful medical aid.
Ill just complain again because to Genesis, they think its okay to take money from clients and not offer the help they said they would. Tell someone with Cancer that if they increase their scheme fund then the medical aid will cover and give more benefits... ITS A LIE. Funny how they say they sympathize with their clients yet once you've made a public complaint then they strip even more from you. As if they had any compassion, there is none.
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Genesis Medical Scheme's replyOfficial
23 Mar 2022, 08:25Dear Brogan
Although you are not a member of Genesis Medical Scheme, we will once again respond to your review as best as we can and within the limits and provisions of the Medical Schemes Act and POPIA.
It is really difficult to respond to a complaint on this platform if the Scheme is accused of "heartlessness" and "spitefulness" given the fact that there has never been any wrongdoing on the part of the Scheme. Whilst the employees of a medical scheme may have all the sympathy in the world for their members, the funding decisions for treatment, however, are solely governed by the benefits and limitations in terms of the rules of a medical scheme.
We mentioned before that your mom, at the time that she was diagnosed and treated for cancer, had selected a benefit option which had very limited cancer benefits. Whilst your mom had subsequently moved to another benefit option, the fact of the matter remains that the rules of a medical scheme determine, inter alia, that a health service / treatment has to be reasonable and supported by sound scientific evidence and that it has to be cost effective in relation to available alternatives.
Medical schemes in South Africa don’t treat their members; they only fund the treatment of their members as provided for by a healthcare service provider (e.g. doctor or specialist). Members may therefore choose any treatment they want, but whether a medical scheme is liable for the funding of such treatment, depends on the rules of that medical scheme. While a chosen procedure may be preferred and may even be supported by scientific evidence and in accordance with generally accepted guidelines and protocols of medical practice, medical schemes are limited in law to the terms of the contract and limits of the benefit option selected by their members (i.e. your mom).
All medical schemes are bound by the provisions of their registered rules, which in turn are consistent with the provisions of the Medical Schemes Act and fair to members. To this end, private healthcare funding is and will always be in strict accordance with the rules of a medical scheme. It has nothing to do with any of the emotive allegations being made.
Yours sincerely
GENESIS MEDICAL SCHEME
Although you are not a member of Genesis Medical Scheme, we will once again respond to your review as best as we can and within the limits and provisions of the Medical Schemes Act and POPIA.
It is really difficult to respond to a complaint on this platform if the Scheme is accused of "heartlessness" and "spitefulness" given the fact that there has never been any wrongdoing on the part of the Scheme. Whilst the employees of a medical scheme may have all the sympathy in the world for their members, the funding decisions for treatment, however, are solely governed by the benefits and limitations in terms of the rules of a medical scheme.
We mentioned before that your mom, at the time that she was diagnosed and treated for cancer, had selected a benefit option which had very limited cancer benefits. Whilst your mom had subsequently moved to another benefit option, the fact of the matter remains that the rules of a medical scheme determine, inter alia, that a health service / treatment has to be reasonable and supported by sound scientific evidence and that it has to be cost effective in relation to available alternatives.
Medical schemes in South Africa don’t treat their members; they only fund the treatment of their members as provided for by a healthcare service provider (e.g. doctor or specialist). Members may therefore choose any treatment they want, but whether a medical scheme is liable for the funding of such treatment, depends on the rules of that medical scheme. While a chosen procedure may be preferred and may even be supported by scientific evidence and in accordance with generally accepted guidelines and protocols of medical practice, medical schemes are limited in law to the terms of the contract and limits of the benefit option selected by their members (i.e. your mom).
All medical schemes are bound by the provisions of their registered rules, which in turn are consistent with the provisions of the Medical Schemes Act and fair to members. To this end, private healthcare funding is and will always be in strict accordance with the rules of a medical scheme. It has nothing to do with any of the emotive allegations being made.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply23 Mar 2022, 08:25
Official
Dear Brogan
Although you are not a member of Genesis Medical Scheme, we will once again respond to your review as best as we can and within the limits and provisions of the Medical Schemes Act and POPIA.
It is really difficult to respond to a complaint on this platform if the Scheme is accused of "heartlessness" and "spitefulness" given the fact that there has never been any wrongdoing on the part of the Scheme. Whilst the employees of a medical scheme may have all the sympathy in the world for their members, the funding decisions for treatment, however, are solely governed by the benefits and limitations in terms of the rules of a medical scheme.
We mentioned before that your mom, at the time that she was diagnosed and treated for cancer, had selected a benefit option which had very limited cancer benefits. Whilst your mom had subsequently moved to another benefit option, the fact of the matter remains that the rules of a medical scheme determine, inter alia, that a health service / treatment has to be reasonable and supported by sound scientific evidence and that it has to be cost effective in relation to available alternatives.
Medical schemes in South Africa don’t treat their members; they only fund the treatment of their members as provided for by a healthcare service provider (e.g. doctor or specialist). Members may therefore choose any treatment they want, but whether a medical scheme is liable for the funding of such treatment, depends on the rules of that medical scheme. While a chosen procedure may be preferred and may even be supported by scientific evidence and in accordance with generally accepted guidelines and protocols of medical practice, medical schemes are limited in law to the terms of the contract and limits of the benefit option selected by their members (i.e. your mom).
All medical schemes are bound by the provisions of their registered rules, which in turn are consistent with the provisions of the Medical Schemes Act and fair to members. To this end, private healthcare funding is and will always be in strict accordance with the rules of a medical scheme. It has nothing to do with any of the emotive allegations being made.
Yours sincerely
GENESIS MEDICAL SCHEME
Although you are not a member of Genesis Medical Scheme, we will once again respond to your review as best as we can and within the limits and provisions of the Medical Schemes Act and POPIA.
It is really difficult to respond to a complaint on this platform if the Scheme is accused of "heartlessness" and "spitefulness" given the fact that there has never been any wrongdoing on the part of the Scheme. Whilst the employees of a medical scheme may have all the sympathy in the world for their members, the funding decisions for treatment, however, are solely governed by the benefits and limitations in terms of the rules of a medical scheme.
We mentioned before that your mom, at the time that she was diagnosed and treated for cancer, had selected a benefit option which had very limited cancer benefits. Whilst your mom had subsequently moved to another benefit option, the fact of the matter remains that the rules of a medical scheme determine, inter alia, that a health service / treatment has to be reasonable and supported by sound scientific evidence and that it has to be cost effective in relation to available alternatives.
Medical schemes in South Africa don’t treat their members; they only fund the treatment of their members as provided for by a healthcare service provider (e.g. doctor or specialist). Members may therefore choose any treatment they want, but whether a medical scheme is liable for the funding of such treatment, depends on the rules of that medical scheme. While a chosen procedure may be preferred and may even be supported by scientific evidence and in accordance with generally accepted guidelines and protocols of medical practice, medical schemes are limited in law to the terms of the contract and limits of the benefit option selected by their members (i.e. your mom).
All medical schemes are bound by the provisions of their registered rules, which in turn are consistent with the provisions of the Medical Schemes Act and fair to members. To this end, private healthcare funding is and will always be in strict accordance with the rules of a medical scheme. It has nothing to do with any of the emotive allegations being made.
Yours sincerely
GENESIS MEDICAL SCHEME