Inconsiderate & Terrible Service!

To my knowledge Gap Cover is there to cover any shortfalls that your medical aid does not pay, thus the reason I signed up with OLD MUTUAL IWYZE GAP COVER.

I recently had a baby about 6 weeks ago, my Medical Aid did not cover a certain portion of the claimed amount from the doctor.... but they covered a part of the claim.

I submitted the claim to IWYZE GAP on the 12th October, received an automated response, claim will be dealt with and payment would be made.. after a few days I received payment but for the incorrect amount, they paid me the amount that medical aid paid the doctor and not the shortfall!!!

I thought maybe this was an error, I then emailed through my query regarding the incorrect amount that was paid to me on the 16th October... after many attempts of trying to get some assistance... I finally received a call from one of there agents who directed the call to Bongiwe Mtshali, I explained my query to her, thereafter she had mentioned that what they paid me is correct, stating that I am on a network medical aid, when I am not, and that there policy had changed last year November with regards to claims, which I do not have any correspondence to.

I then spoke to her Team Leader/Manager... he mentioned that IWYZE will only cover what medical aid paid for and not the total amount of the short fall, If I had known this I would have immediately changed my Gap Cover Provider, and further to this, I submitted a claim last year around April/May & IWYZE covered the total shortfall, so to my mind I knew that my claim would be covered.

During the course of this year I had spoken to a consultant from IWYZE querying a claim that I had and he explained why he could not cover that specific claim, which was due to medical aid not covering the amount claimed for at all, and he mentioned IWYZE will only cover a claim if Medical Aid Covered a portion of the amount and the balance would be paid from IWYZE GAP COVER, this conversation was done telephonically which should be recorded. The manager that I spoke mentioned that I cannot hold the consultant liable for what they had said to me, this is why we call into the call center to get assistance from the consultants to provide correct information, a reputable company like OLD MUTUAL IWYZE should have properly trained there staff to offer correct services to there customers, which we go by.

The Manager specifically told me that he will investigate my current claim and get back to me by the 21st October COB, still no reply or feedback.

I am not on any network plan, So my shortfall should be covered by IWYZE, which I need to pay to my doctor. What was mentioned to me during the course of this year by the consultant and what is been told to me now is completely different to what Bongiwe explained on how there gap cover claims work which I had no knowledge of them changing there policy. They are contradicting there statements.

This is horrible and inconsiderate service and terrible communication that is been provided.

I have kept to my premiums expecting great service when required and in a case like this. I expected my claim to be covered in full!

This is supposed to be the most happiest time of my life, but yet, here I am stressing over IWYIZE not covering my claim, Which I was aware that they would, when I signed up my Policy and to have peace of mind.