Momentum Health - unfair treatment and slow delayed service during claim.

I joined Momentum on 1st April 2018, after being with Resolution for 8 years. I was under my parent's medical aid as a student, and needed to change to my own medical aid, given that I am now working and no longer a student. I had to declare an existing disorder, osteogenisis imperfecta, although it has not affected me for 10 years.

Momentum gave me a 3 month waiting GENERAL period, due to declaring the pre-existing condition. An adviser assured us that, if something were to happen during the 3 month waiting period, I would be sent to the nearest hospital, and Momentum would cover the emergency treatment at that nearest hospital before being transferred to state hospital.

On 6 April 2018, 6 days into the waiting period, I was involved in an accident, and taken to the nearest hospital, Olivedale Clinic. I suffered a dislocated elbow, and small fracture on the radius and femur. The surgeon agreed that if I was still affected by ostegenesis, my elbow would be crushed and I would have broken many more bones. The injuries i suffered are consistent with what a normal person would have suffered being involved in such a collision. There is a small bone fragment in my elbow, which may need to be removed by way of a key-hole surgery which will cost over R200 000. We obviously can't afford such, HENCE WE PAY MEDICAL AID PREMIUMS TO COVER OURSELVES IN THESE UNFORESEEN EVENTS.

Momentum have rejected every single claim from Olivedale Clinic. We have been fighting for answers and 6 weeks down the line, we have not received an answer.

I believe it is extremely unfair that ALL expenses have been rejected. I have been a loyal member of medical aid for numerous years, without a single break in cover. I was forced to move to my own medical aid now that I am no longer a student and worried that I would not be covered in the event of a medical claim, and of course I had to declare the existing condition, even though I am not on any chronic medication nor receiving ongoing treatment, and haven't needed treatment for the disorder for over 10 years, I believe it is extremely wrong and unfair to give me a 3 month general waiting period.

In the circumstances, what is one to do? - If i stayed on my parent's medical aid, I risked rejection as I am no longer a student. - If i did not declare the pre-existing condition as it no longer affects me, I would most likely have been rejected and called a ***** for non-disclosure. - It seems all outcomes are against me, and forces one to live in a bubble for 3 months, even though premiums are being paid, and STILL being paid, for what exactly I am beginning to question.

I needed to change over to my own medical aid... I believe they should not be allowed to issue a waiting period for such a mandatory move from my parents plan to my own medical plan?

The service we have received thus far has been extremely slow and delayed. We are receiving outstanding accounts from the hospital, and it is extremely stressful not knowing what is going on given that Momentum have not given us an answer, especially with the pending requirement for an operation.

***Should the answer be no to all claims, we will certainly be raising this case with the Ombud***

I am reaching out here, to prompt a response from Momentum, before we escalate this further.