WG Wade Admed Gap Cover Policy *** co-payment in respect of hospitalisation HJ Wade Discovery membership number ***

This review is in respect of the Guardrisk Admed Gap Policy Cover under policy number ********** 4 WG Wade with a cover start date of 1st January 2002. It should be understood that this is not about Rands and Cents but rather about really poor service.

First off I must state that I belong to Discovery's Coastal Saver Plan. This requires that all medical needs have to be attended to at the coast. We recently had a situation where my wife had to have an emergency hernia operation at the Unitas Hospital in Irene. To explain we live in Jeffreys Bay and our doctor referred us to a surgeon for a gastroscopy. The surgeon has a large practice in Irene but has a home in Jeffreys Bay which he visits every second month. When he is here he does gastroscopy's the one month and operations when he next visits. In my wife's case she was deemed a serious case and it was recommended the procedure be done in Irene.

On our return I put in a claim for the shortfall Discovery paid in respect of the surgeon and anaesthetists. In addition their were co-payments made to Unitas Hospital for which I claimed as well. Our understanding was that this was what Gap cover was for.

I completed the documentation to the best of my ability as well as attaching whatever documents I thought Admed required. This is where the fun and games begun as I would submit documentation only to be told they needed something else. This I must add was usually a follow up from myself as I had not received a response to my email. Finally after a number of email exchanges and a telephone call I received an email from Admed and I quote " your claim has been approved " Needless to say we were very pleased with the outcome which created the expectation that we would receive the full amount claimed.

Three days later I checked my account only to find that I had been credited with only R2915 against a total claim of + - R15000. I emailed Admed asking when I could expect to receive the balance only to be told that because I was on a " coastal plan " I did not qualify as the operation had been done up country. Why wait until I queried it before advising me that the co-payment would not be paid.

I have expressed my displeasure in the manner this claim was handled by email ( which included all previous email exchanges ) to which I have received no reply. Admed showed absolutely no respect to myself as a policy holder which leads me to believe that other policy holders will have suffered the same fate.

The service and lack of communication from Admed leaves a lot to be desired and is not acceptable in this day and age.