BS
Brian S
1 reviews | Active since Oct 2019
30 Mar 2021, 03:52
You lucky you received even 1 star
Let me start off by saying that Genesis is extremely lucky that the rating starts at 1 star, for there service they deserve zero stars. I actually can't believe that your company takes peoples hard earned money and rejects claims.
My 12 year old son was taken to hospital ( Emergency section Constantiaberg Medi Clinic ) during this pandemic ( Feb 2021 ) with an extremely high temp, and vomiting. He was seen by doctors, taken for xrays, put on a drip, did a Covid19 test. In the hospital he continued to vomit into his face mask. Do you have any idea what that does to a 12 yeard old child ?? I don't think you do as your company cares about how much money they can make off people , instead of helping people.
Thank God my son came out on top. We put the claim in for the hospital, doctors and medicine, not one of those claims were approved, all rejected, all of them !! I have since cancelled my membership with Genesis, and have urged all my family, friends, colleagues, and anyone I meet, to do the same. You don't deserve my money, I hope that people read this and cancel as well. You don't deserve to be in business.
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Replies (2)
Genesis Medical Scheme's replyOfficial
30 Mar 2021, 17:34Dear Brian
Your feedback and frustration in this regard is unfortunately a scenario for many members of medical schemes in South Africa.
The emergency rooms at private hospitals are not owned by the hospitals. Instead, they are owned by private practicing doctors. Where appropriate, patients are treated at these facilities, but when clinically or medically appropriate, the patient will be admitted from the emergency rooms into hospital.
If a patient is treated (by means of a consultation, diagnostic tests, etc.) at the emergency rooms and then sent home, he / she were never admitted into hospital. As a result, such a visit is in essence the same as a visit to your GP’s rooms.
If, in the opinion of the treating doctor at the emergency practice, the patient cannot be treated in the emergency practice, he / she will have the patient admitted into hospital, where the patient will receive medically appropriate treatment and where the medical scheme will fund such treatment in line with the in-hospital benefits the patient has.
As much as the acute condition your son was diagnosed with, was traumatic for him (and very concerning for you as his parents), his condition was not a medical emergency or PMB that qualified for in-hospital treatment.
People often think that the emergency rooms at a private hospital are part of the hospital, where in fact, it is not the case. Such a practice is usually owned by a group of doctors that are in no way part of the hospital. Treatment received at such a practice, is never regarded as in-hospital treatment if the patient is sent home again. To this end, treatment or services received, e.g. blood tests, X-rays, stitches, drip, medication, etc. will only be covered from the member’s out-of-hospital benefits, i.e. a medical savings account.
From time to time medical schemes are accused of being a rip-off, being heartless or being money-hungry “******” when they decline a benefit, or don’t settle a claim in full or at all. The simple truth of the matter is however that claims are rejected, or short paid, because the rules of the scheme are being app****. No benefits may exist outside of the scheme rules. In your instance, the claims were rejected as your son was not admitted to and treated in the hospital.
The Medical Schemes Act forces schemes to apply their registered rules. Whether members like it or not, membership of a medical scheme is on the basis of a legal contract and medical schemes are not companies taking members’ money. Unfortunately, it sometimes takes a very worrying and traumatic situation (such as faced by your son and your family) before one takes notice of what it is that you in fact have in the way of benefits. You will find exactly the same situation at every other medical scheme. Whilst members may elect to have more benefits, they will undoubtedly pay much higher contributions. Benefits and contributions go hand-in-hand.
We trust that our explanation in this regard will provide you with more clarity as to why your claims were not paid from your in-hospital benefits.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME
Genesis Medical Scheme's reply30 Mar 2021, 17:34
Official
Dear Brian
Your feedback and frustration in this regard is unfortunately a scenario for many members of medical schemes in South Africa.
The emergency rooms at private hospitals are not owned by the hospitals. Instead, they are owned by private practicing doctors. Where appropriate, patients are treated at these facilities, but when clinically or medically appropriate, the patient will be admitted from the emergency rooms into hospital.
If a patient is treated (by means of a consultation, diagnostic tests, etc.) at the emergency rooms and then sent home, he / she were never admitted into hospital. As a result, such a visit is in essence the same as a visit to your GP’s rooms.
If, in the opinion of the treating doctor at the emergency practice, the patient cannot be treated in the emergency practice, he / she will have the patient admitted into hospital, where the patient will receive medically appropriate treatment and where the medical scheme will fund such treatment in line with the in-hospital benefits the patient has.
As much as the acute condition your son was diagnosed with, was traumatic for him (and very concerning for you as his parents), his condition was not a medical emergency or PMB that qualified for in-hospital treatment.
People often think that the emergency rooms at a private hospital are part of the hospital, where in fact, it is not the case. Such a practice is usually owned by a group of doctors that are in no way part of the hospital. Treatment received at such a practice, is never regarded as in-hospital treatment if the patient is sent home again. To this end, treatment or services received, e.g. blood tests, X-rays, stitches, drip, medication, etc. will only be covered from the member’s out-of-hospital benefits, i.e. a medical savings account.
From time to time medical schemes are accused of being a rip-off, being heartless or being money-hungry “******” when they decline a benefit, or don’t settle a claim in full or at all. The simple truth of the matter is however that claims are rejected, or short paid, because the rules of the scheme are being app****. No benefits may exist outside of the scheme rules. In your instance, the claims were rejected as your son was not admitted to and treated in the hospital.
The Medical Schemes Act forces schemes to apply their registered rules. Whether members like it or not, membership of a medical scheme is on the basis of a legal contract and medical schemes are not companies taking members’ money. Unfortunately, it sometimes takes a very worrying and traumatic situation (such as faced by your son and your family) before one takes notice of what it is that you in fact have in the way of benefits. You will find exactly the same situation at every other medical scheme. Whilst members may elect to have more benefits, they will undoubtedly pay much higher contributions. Benefits and contributions go hand-in-hand.
We trust that our explanation in this regard will provide you with more clarity as to why your claims were not paid from your in-hospital benefits.
Yours sincerely
GENESIS MEDICAL SCHEME
Yours sincerely
GENESIS MEDICAL SCHEME
BS
Brian S's updateReviewer Update
30 Mar 2021, 17:42So then what are people paying medical aid for ? This is not the first time for me or other members that Genesis has rejected claims. You were not in the emergency ward with my son, and you did not have to go through at that time what he, or us as his parents went through. You can give any explanation you want, but I for one am glad that I am not part of your medical aid anymore. Please don't contact me with regards to anything as I will not read or respond to anything from Genesis, and will continue to let people know of my experience with your medical aid scheme.
BS
Brian S's update30 Mar 2021, 17:42
Reviewer Update
So then what are people paying medical aid for ? This is not the first time for me or other members that Genesis has rejected claims. You were not in the emergency ward with my son, and you did not have to go through at that time what he, or us as his parents went through. You can give any explanation you want, but I for one am glad that I am not part of your medical aid anymore. Please don't contact me with regards to anything as I will not read or respond to anything from Genesis, and will continue to let people know of my experience with your medical aid scheme.