ES
Elvera S

1 reviews | Active since Jun 2017

06 May 2019, 07:59

Refusal to pay out claim without reason (possible breach of contract)

Case Ref number: ********** 543

For a month now I have been trying to get my claim paid out. It was rejected due to an early refill. I have asked several times for the policy wording stipulating that Momentum won't pay for early refills as well as a reason for this policy (if it even exist). If you cannot show you have a contract with me stipulating early refills won't be covered you are in breach of contract. I am traveling and often an hour or more away from the nearest pharmacy thus non regular refills can be expected for the foreseeable future. I have explained everything in detail in several emails which are now being ignored.

I never do early claims which is the only thing Momentum should be concerned about. 4 months has passed, 4 claims has been submitted but for some reason you refuse to pay out claim number 3 because it was refilled early.

I am taking this to social media if this does not get resolved soon.

I am insisting on 2 outcomes for this complaint: 1. The contractual policy wording stating that early refills are not covered. 2. A status update on the claim for medication paid for 21-Feb, claimed 10-Apr, and still not paid.

0
Replies (4)
Momentum Health
Momentum Health's reply06 May 2019, 11:33
Official
 Dear Elvera Strydom 
 
We are currently looking into your query  and will contact you shortly to provide feedback. 
 
Kind regards 
 
Roger Naidoo 
ES
Elvera S's update14 May 2019, 09:39
Reviewer Update
Still no response from Momentum 1 week later.
Momentum Health
Momentum Health's reply14 May 2019, 14:51
Official
  Dear Elvera 
 
As per our telephone conversation this morning, the claims is in progress  with our claims resolution team. 
I will inform you via email once the claim has been assessed. 
 
Kind regards 
 
Roger Naidoo 
Momentum Health
Momentum Health's reply15 May 2019, 08:26
Official
Dear Elvera 
 
I can confirm the claim has been assessed  and an email to this effect was sent to you. 
 
Kind regards 
 
Roger Naidoo