Western/ Kaelo Gap, dont use them unless them unless you want to be totally **********.

Xelus Specialised Insurance Solutions are better known for their medical GAP cover under the name of Kaelo or Western Gap. Their advertising states " Western Gap ensures you are able to choose the best medical care for your family by covering shortfalls your medical scheme does not". There other pamphlet states "Western Gap provides you with peace of mind and financial cover for in hospital medical shortfalls that your medical scheme does not cover " Makes you feel really good that you wont have huge medical shortfalls on hospital shortfalls - but do not be sucked in like I was.

On the 4 March I had knee replacement surgery and just last week, mainly dues to incompetence at Western Gap I was not paid for my shortfall on my hospital account which amounted to approx R24000,00 . On querying this with Western Gap I was informed that in terms of their GENERAL EXCEPTIONS DO NOT COVER. ALL COSTS RELATED TO HOSPITAL WARD FEES,THEATRE FEES AND OTHER HOSPITAL EXPENSES INCLUDING MATERIALS AND MEDICATION ON THE HOSPITAL ACCOUNT. In my case my medical aid pays the ward fees but my shortfall was on the theatre fees which includes the prostheses required for knee surgery.

So here we have a GAP insurance company proudly advertising "peace of mind to choose the best medical care" in hospital when they TOTALLY EXCLUDE ALL THE HOSPITAL RELATED COSTS. They did pay shortfalls on the surgeons and anesthetists feels however I ask how an insurance company can advertise what they do and totally exclude all hospital related fees. Does this really make sense.

And yes in the small print in their policy they do state they exclude Hospital fees. But does this really comply with their slogans or is it just blatant misleading advertising. You make up your mind.

I am also referring this matter to the Ombudsman as I am really tired of being "**********" by insurance companies.