ES
Elvera S

1 reviews | Active since Jun 2017

23 Dec 2019, 09:18

Next level incompetence in processing claim

So here is what happened over the last 3 weeks in trying to get a claim processed.

Me: submits claim 9 December noting that I had to collect my medication slightly early because I was traveling to a remote area in South Africa hours away from a suitable pharmacy

Momentum: no response for days

Me: “Kindly following up regarding claim”

Momentum: Please provide travel itinerary and flight tickets for consideration of processing early refill.

Me: I was traveling to a remote area in South Africa and have no tickets, etc. Secondly and more importantly, as I have pointed out with a similar complaint months ago you have a legal obligation to pay a timely claim regardless of when the medication was obtained. There are 12 months in a year which means you have to pay 12 times per year its not that complicated. If you disagree kindly provide a the contract I signed indicating that you do not have to pay for early refills even if the claim is timely.

Momentum: Please note we require the departure and return dates for review by the fund department

Me: Starting to laugh at the incompetence but provide dates nonetheless guessing the return date because I do not know when I will return. For the record I stay at our remotely located holiday home when I want for how long I want - not sure what this has to do with Momentum and my claim.

Momentum: No response for days

Me: Following up on claim. Either provide contract stipulating your policy on early refills or pay out the claim.

Momentum: Sends a random document indicating my registered chronic conditions not even remotely addressing the “early refill” aspect.

Me: no response

Momentum: Randomly approves the claim days later and pays the supplier (yes you read that right, the supplier not me who lodged the claim)

Me: You have paid the supplier not me please advise.

Momentum: no response for days

Me: Following up regarding incorrect payment to supplier instead of me. (at this point also starting to google for alternative medical aid plans at other providers)

Momentum: Please note we require proof of purchase of said claim.

Me: Sends exact same documents I sent weeks ago when I initially lodged the claim.

Me: no response for days

Today: filing complaint.

There do not exist words to describe the utter incompetence. Pay out my claim or the next stop will be the Ombudsman. I will also be getting legal advice on this including trying to get compensated for my time invested in this nonsense.

0
Replies (2)
Momentum Health
Momentum Health's reply23 Dec 2019, 09:24
Official
Hi Elvera

We are sorry we made you feel this way. One of our consultants will contact you shortly to discuss.

Regards

Debbie Van Der Haar. 
ES
Elvera S's update23 Dec 2019, 10:03
Reviewer Update
Thank you. Please note I am only available via email.