TJ
Talha J
1 reviews | Active since Jul 2012
26 Feb 2024, 20:54
STAY AWAY from the Genesis MED-100 Hospital Plan!
MED-100 Hospital Plan is a waste of money. It will not cover you for even the smallest or most minor of injuries. I'm still paying for óut-of network' specialists more than a year later! My claim was for in-hospital surgery (I was kept in hospital for 3 days) with skeleton staff and specialists with no notification that the attending anaesthetist was not on network and will not be covered by the MED-100 plan. STAY AWAY. The cover is minimal and won't even cover a minor broken wrist!!
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Replies (3)0
Replies (3)
Genesis Medical Scheme's replyOfficial
28 Feb 2024, 10:23Dear Mr Jeena
You seem to be very economical with your feedback and we do invite you to state all the facts.
Be that as it may, there is no reason why anyone should follow your advice and stay away from our MED-100 benefit option. It is also not a waste of money. To the contrary, it is being independently rated as one of the best-value-for-money hospital plans in South Africa!
We would further like to place on record that Genesis does not have network doctors / hospitals. You were well aware of this fact, as you have received no less than five emails from the Scheme in this regard during your relatively short period of membership. These emails consistently highlighted the following important facts:
- Members are not forced to use public hospitals for the treatment of PMBs;
- PMB treatment will be reimbursed in full when treatment is obtained from a public hospital;
- The voluntary treatment of PMBs in private hospitals will be funded in full, unless your service provider(s) charges more than the Genesis tariff of your selected benefit option;
- If you select (choose) to have your treatment in a private hospital, then you will be liable for the shortfall (if any) between what your service provider(s) charged and your stated benefit options and Scheme Tariff; and
- In the event of an emergency (any life-threatening condition which, without immediate treatment, will or may result in the loss of your life) and where the nearest hospital is a private hospital, the Scheme will cover such a claim in full.
To put the above information in context and to perhaps explain your outstanding medical bills along what is stated above and in line with your (at the time) selected benefit option, the following information is of relevance:
- Your injury was not an emergency (as defined in the Medical Schemes Act). It was a booked procedure, or voluntary admission, to a private hospital.
- Prior to your surgery you, as well as the private hospital and the specialist, received a reference letter from the Scheme where the following important information was communicated:
- The letter encouraged you to read the letter carefully to ensure that you were fully informed regarding the Scheme Rules that were applicable to hospital admissions and also to avoid unexpected and unplanned out-of-pocket expenses;
- It stated that your hospital costs would be reimbursed at the Scale of Benefits (“Scheme Tariff”) in accordance with the Scheme Rules and that the cost of doctor(s) and other service providers would be reimbursed in accordance with the Scheme Rules applicable to your benefit option;
- It further explained that when doctors charge more than the reimbur*****t rate (“Scheme Tariff”) applicable to your benefit option, or when they perform health services, use advanced technology or use / order certain diagnostic or other tests and procedures which are not deemed medically appropriate in terms of the Scheme Rules, your accounts may not be settled in full;
- You were encouraged to discuss such charges and / or services or treatment with your doctor(s) before your admission and / or procedure(s) in order to avoid potential co-payments or unexpected expenses; and
- You were reminded that, should you choose to be treated in a private hospital, the benefits and limits, as set out in the Rules, would apply and that any shortfalls that there may be would be for your account. You were again made aware of the fact that, should you wish claims to be paid according to the law as provided for in section 29(1)(p) of the Medical Schemes Act, then treatment must be obtained from a public hospital.
Whilst we can understand that you are upset about a portion of your claims that were not paid in full, the Scheme is not at fault, as your benefits and limits have been clearly communicated to you. Your claims were also assessed and reimbursed in line with the Scheme Rules and your selected benefit option. When you joined Genesis, you voluntarily entered into a binding contract and you declared that you had read the rules and that you would be bound by them. It is unfortunate that you now blame and slander Genesis when perhaps, you failed to have regard to the contract that you signed. In addition, the Scheme is precluded by law from disclosing details of your health condition. We invite you to disclose publicly the full details of your admission so that readers can decide for themselves whether the Scheme deserves you slanderous remarks.
Should anything still be unclear to you and / or if you disagree with what is said above, we invite you to indicate in applicable rules of Genesis that inform your entitlement to the benefits that you demand.
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply28 Feb 2024, 10:23
Official
Dear Mr Jeena
You seem to be very economical with your feedback and we do invite you to state all the facts.
Be that as it may, there is no reason why anyone should follow your advice and stay away from our MED-100 benefit option. It is also not a waste of money. To the contrary, it is being independently rated as one of the best-value-for-money hospital plans in South Africa!
We would further like to place on record that Genesis does not have network doctors / hospitals. You were well aware of this fact, as you have received no less than five emails from the Scheme in this regard during your relatively short period of membership. These emails consistently highlighted the following important facts:
- Members are not forced to use public hospitals for the treatment of PMBs;
- PMB treatment will be reimbursed in full when treatment is obtained from a public hospital;
- The voluntary treatment of PMBs in private hospitals will be funded in full, unless your service provider(s) charges more than the Genesis tariff of your selected benefit option;
- If you select (choose) to have your treatment in a private hospital, then you will be liable for the shortfall (if any) between what your service provider(s) charged and your stated benefit options and Scheme Tariff; and
- In the event of an emergency (any life-threatening condition which, without immediate treatment, will or may result in the loss of your life) and where the nearest hospital is a private hospital, the Scheme will cover such a claim in full.
To put the above information in context and to perhaps explain your outstanding medical bills along what is stated above and in line with your (at the time) selected benefit option, the following information is of relevance:
- Your injury was not an emergency (as defined in the Medical Schemes Act). It was a booked procedure, or voluntary admission, to a private hospital.
- Prior to your surgery you, as well as the private hospital and the specialist, received a reference letter from the Scheme where the following important information was communicated:
- The letter encouraged you to read the letter carefully to ensure that you were fully informed regarding the Scheme Rules that were applicable to hospital admissions and also to avoid unexpected and unplanned out-of-pocket expenses;
- It stated that your hospital costs would be reimbursed at the Scale of Benefits (“Scheme Tariff”) in accordance with the Scheme Rules and that the cost of doctor(s) and other service providers would be reimbursed in accordance with the Scheme Rules applicable to your benefit option;
- It further explained that when doctors charge more than the reimbur*****t rate (“Scheme Tariff”) applicable to your benefit option, or when they perform health services, use advanced technology or use / order certain diagnostic or other tests and procedures which are not deemed medically appropriate in terms of the Scheme Rules, your accounts may not be settled in full;
- You were encouraged to discuss such charges and / or services or treatment with your doctor(s) before your admission and / or procedure(s) in order to avoid potential co-payments or unexpected expenses; and
- You were reminded that, should you choose to be treated in a private hospital, the benefits and limits, as set out in the Rules, would apply and that any shortfalls that there may be would be for your account. You were again made aware of the fact that, should you wish claims to be paid according to the law as provided for in section 29(1)(p) of the Medical Schemes Act, then treatment must be obtained from a public hospital.
Whilst we can understand that you are upset about a portion of your claims that were not paid in full, the Scheme is not at fault, as your benefits and limits have been clearly communicated to you. Your claims were also assessed and reimbursed in line with the Scheme Rules and your selected benefit option. When you joined Genesis, you voluntarily entered into a binding contract and you declared that you had read the rules and that you would be bound by them. It is unfortunate that you now blame and slander Genesis when perhaps, you failed to have regard to the contract that you signed. In addition, the Scheme is precluded by law from disclosing details of your health condition. We invite you to disclose publicly the full details of your admission so that readers can decide for themselves whether the Scheme deserves you slanderous remarks.
Should anything still be unclear to you and / or if you disagree with what is said above, we invite you to indicate in applicable rules of Genesis that inform your entitlement to the benefits that you demand.
Yours sincerely
GENESIS MEDICAL SCHEME
TJ
Talha J's updateReviewer Update
28 Feb 2024, 10:56This is exactly the reason I advise anyone not to go with your plan. This back and forth, and as I said, it was simple surgery. I admitted into casualty as I was admitted as an emergency. I'd have not accepted admission into the ward had known that I was then going to be kept in the hospital until the attending surgeon was available (2 days later) At no point was I made aware that the attending specialists (the only specialists that were available as it was new years weekend) will be billing me higher than the scheme tariff. I was also notified by the hospital that if I choose not to be admitted as an emergency This is why I am now (not slandering) but discouraging anyone from choosing your MED-100 plan. The hassle and inconvenience (and then extra cost) is just not worth it! If your plan is not sufficient to cover a relatively minor injury, what does it cover? We've been through this back and forth communication via email for more than a year. It's time consuming and unnecessary. I understand that the plan does not cover the higher than scheme tariff rates and if you do want to have cover that sufficient for even a minor injury, choose a better (more expensive) plan and add additional GAP cover.
TJ
Talha J's update28 Feb 2024, 10:56
Reviewer Update
This is exactly the reason I advise anyone not to go with your plan. This back and forth, and as I said, it was simple surgery. I admitted into casualty as I was admitted as an emergency. I'd have not accepted admission into the ward had known that I was then going to be kept in the hospital until the attending surgeon was available (2 days later) At no point was I made aware that the attending specialists (the only specialists that were available as it was new years weekend) will be billing me higher than the scheme tariff. I was also notified by the hospital that if I choose not to be admitted as an emergency This is why I am now (not slandering) but discouraging anyone from choosing your MED-100 plan. The hassle and inconvenience (and then extra cost) is just not worth it! If your plan is not sufficient to cover a relatively minor injury, what does it cover? We've been through this back and forth communication via email for more than a year. It's time consuming and unnecessary. I understand that the plan does not cover the higher than scheme tariff rates and if you do want to have cover that sufficient for even a minor injury, choose a better (more expensive) plan and add additional GAP cover.
Genesis Medical Scheme's replyOfficial
28 Feb 2024, 11:18Gap cover can come very handy, especially when a medical scheme benefit option covers 100% of the scheme rate.
Genesis Medical Scheme's reply28 Feb 2024, 11:18
Official
Gap cover can come very handy, especially when a medical scheme benefit option covers 100% of the scheme rate.