Terrible claims service

I am trying to finalise a GAP cover claim with Kaelo GAP cover. I was admitted to Life Vincent Pallotti for surgery on 22 May 2025 and had to pay an admission fee of R12 200 since the hospital is not on my plan.

Needless to say, Kaelo knows what medical aid I am on, and I also sent them the policy from my medical aid about the penalty because the hospital is not on my plan. It is quite self-explanatory that the medical aid would not cover this amount.

I sent them the statement of account showing that I privately paid this together with the medical aid policy stating the amount of the penalty. The hospital never submitted this co-payment to my medical aid due to the fact that it is a penalty payable upfront and will not be covered by my medical aid.

As a GAP cover service provider Kaelo should know this, but instead are delaying the GAP claim finalisation regardless of ample support for the claim. Together with this I also got an email requesting all the documents I had already submitted on the website when initiating my claim - I also had to phone them to clarify this issue. It seems like very little care or pride is taken by the reviewers when reviewing a claim. I pay my monthly premium on time and in the past 4 years of doing so, this is my first time trying to claim.

The service and lack of proper review and application of common sense is shocking.