NG
Nontombi G
1 reviews | Active since Feb 2017
09 Feb 2017, 15:42
Discriminatory practices!
<p>I was on GEMS for the entire duration of 2016 and decided to change medical aids in a bid to cut costs and GEMS was becoming too expensive. So like any other South African trying to save costs I opted to explore different options. I sent a request on Hippo and was contacted by an agent on behalf of Medihelp. I have a chronic condition which I disclosed upon application. I app**** on 3 November and gave notice to GEMS shortly after my acceptance to the scheme was confirmed. I was therefore resigned from GEMS at end of December 2016. In January 2017 upon regular routine check up with my doctor I discovered I was pregnant, upon discussing the matter further it was established that I am about 12 weeks. I had my last periods on 15 October 2016. I communicated the information to the medical aid and they immediately terminated my membership due to non-disclosure! I try to argue the case that there was no way I could have known for sure that I was pregnant at the time of the application which was but only a week or two after my last period. I tried to even explain to the medical aid that I often missed my periods due to the medication I am on and that I was not too alarmed when I missed my periods in Nov 2016. But when I missed my periods again in Dec 2016 I became a bit concerned that it could either be the medication acting up again or I may have fallen pregnant. We have been trying to conceive since 2014 and this was communicated to the medical aid rep as well upon application. I went to update my new medical aid details with my doctor and also asked for a pregnancy tests to be included in my routine blood test, the test confirmed positive and I was estimated at about 14 weeks as at 24 Jan 2017 (date of scheduled check up). The medical aid requested a motivation from my doctor as well as the blood test which they were provided with indicating when I did my test etc. I was rather shocked that they called me today on 9 February 2017 that they have decided to terminate my entire medical aid, terminating ALL my benefits with immediate effect! I do not believe this is fair practice as I feel the conditions surrounding the situation were not evaluated and considered fairly! It was not like I was stranded without medical aid and wanted to join a medical aid simply because I am pregnant. Had I known I am pregnant I would have stayed with GEMS for at least another year until delivery, why on earth would I intentionally put myself through this stres? I am well aware of the conditions of medical aid and wouldnt have made the leap at such a time. I am shocked that the entire medical aid was cancelled. I would have tought if they denied me benefits it would only be the pregnancy/maternity benefits but not terminate my membership entirely! What about my chronic situation at this time? Meaning I have to change medical aids and again register on chronic etc. I feel this step was way too drastic and all angles were not considered. I feel they had made their decision before even asking the doctor and myself for motivation. I would like you to look into this and advice what my options are.</p>
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Medihelp's replyOfficial
10 Feb 2017, 07:41Dear Egaleka
Thank you for taking the time to bring your complaint to our attention.
You are within the first year of membership and it is Medihelp’s policy to investigate all benefit requests during the first year of membership, to ensure that all information was declared on the application form. Authorization is subject to investigation for possible pre-existing conditions
We are currently investigating the matter and you will receive feedback from one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
Medihelp's reply10 Feb 2017, 07:41
Official
Dear Egaleka
Thank you for taking the time to bring your complaint to our attention.
You are within the first year of membership and it is Medihelp’s policy to investigate all benefit requests during the first year of membership, to ensure that all information was declared on the application form. Authorization is subject to investigation for possible pre-existing conditions
We are currently investigating the matter and you will receive feedback from one of our consultants.
Kind regards
Medihelp Customer Care
Best regards,
NG
Nontombi G's updateReviewer Update
10 Feb 2017, 10:10Thank you for the response. I completely understand the procedure. What I find most distasteful is that you did not take any of the facts around the matter into consideration AT ALL! I apply to you on 3 Nov 2016 and fall pregnant within the same month, how on earth was I suppose to have known?? You make it sound as if I voluntary withheld information. How many women immediately know they are pregnant? During our first interaction on Monday I think, your consultant Brenda immediately said that I was 20 weeks pregnant as at 1 Jan 2017 whereas the doctor confirmed that I am about 14 weeks on 24 January 2017. That to me was already a sign that you have already made up your minds without even taking ALL the facts into consideration. Then again, my doctor said that seeing that my last period was 15 October 2016, I could have fallen pregnant in November 2016 so how on earth could I have been 20 weeks and now 12 weeks and 3 days pregnant on 1 January 2017 according to your email and reason for termination? Unless, my doctor has no idea what she is talking about and I should be consulting Brenda to monitor my pregnancy she clearly knows more about it than the doctor does! I also fail to understand why am I not just denied the maternity benefits instead of terminating the whole medical aid????
NG
Nontombi G's update10 Feb 2017, 10:10
Reviewer Update
Thank you for the response. I completely understand the procedure. What I find most distasteful is that you did not take any of the facts around the matter into consideration AT ALL! I apply to you on 3 Nov 2016 and fall pregnant within the same month, how on earth was I suppose to have known?? You make it sound as if I voluntary withheld information. How many women immediately know they are pregnant? During our first interaction on Monday I think, your consultant Brenda immediately said that I was 20 weeks pregnant as at 1 Jan 2017 whereas the doctor confirmed that I am about 14 weeks on 24 January 2017. That to me was already a sign that you have already made up your minds without even taking ALL the facts into consideration. Then again, my doctor said that seeing that my last period was 15 October 2016, I could have fallen pregnant in November 2016 so how on earth could I have been 20 weeks and now 12 weeks and 3 days pregnant on 1 January 2017 according to your email and reason for termination? Unless, my doctor has no idea what she is talking about and I should be consulting Brenda to monitor my pregnancy she clearly knows more about it than the doctor does! I also fail to understand why am I not just denied the maternity benefits instead of terminating the whole medical aid????