NM
Nozipho M
1 reviews | Active since Sept 2022
26 Sept 2022, 10:22
Appalled
Taking this medical insurance was the worst decision ever. My sister signed up and she did not receive any help yesterday. I had to go back home with her while she was in pain simply because her vital signs were normal. I did not get through to the call center, after holding the line for over 30 minutes it went to voice mail and this happened twice. I am seriously appalled by this
Helpful (0)
Replies (3)0
Replies (3)
Oneplan Insurance's replyOfficial
26 Sept 2022, 11:32Good day Nozipho,
Thank you for taking the time to bring this to our attention.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your sister's best interest at heart and wish that she is having a speedy recovery.
Kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF policy to ensure all our clients receive fair service and cover.
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with the policy holder to further discuss the matter at hand.
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your sister's best interest at heart and wish that she is having a speedy recovery.
Kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF policy to ensure all our clients receive fair service and cover.
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with the policy holder to further discuss the matter at hand.
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan
Oneplan Insurance's reply26 Sept 2022, 11:32
Official
Good day Nozipho,
Thank you for taking the time to bring this to our attention.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your sister's best interest at heart and wish that she is having a speedy recovery.
Kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF policy to ensure all our clients receive fair service and cover.
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with the policy holder to further discuss the matter at hand.
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your sister's best interest at heart and wish that she is having a speedy recovery.
Kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF policy to ensure all our clients receive fair service and cover.
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with the policy holder to further discuss the matter at hand.
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan
NM
Nozipho M's updateReviewer Update
27 Sept 2022, 18:43That is something that should have been communicated before she took this insurance. And secondly she Sunday was not the first time she used the card with the same problem previously she was treated. I just don't get why she did not get assistance this time around
NM
Nozipho M's update27 Sept 2022, 18:43
Reviewer Update
That is something that should have been communicated before she took this insurance. And secondly she Sunday was not the first time she used the card with the same problem previously she was treated. I just don't get why she did not get assistance this time around
Oneplan Insurance's replyOfficial
28 Sept 2022, 15:48Good day Nozipho,
Kindly note that all of the above information was provided to the client as the policy documents is sent to the policy holders email address before the inception of the policy. Upon receiving the query, the policy holder was contacted, and a further explanation was provided in line with our policy terms and conditions.
Kind Regards,
Oneplan
Kindly note that all of the above information was provided to the client as the policy documents is sent to the policy holders email address before the inception of the policy. Upon receiving the query, the policy holder was contacted, and a further explanation was provided in line with our policy terms and conditions.
Kind Regards,
Oneplan
Oneplan Insurance's reply28 Sept 2022, 15:48
Official
Good day Nozipho,
Kindly note that all of the above information was provided to the client as the policy documents is sent to the policy holders email address before the inception of the policy. Upon receiving the query, the policy holder was contacted, and a further explanation was provided in line with our policy terms and conditions.
Kind Regards,
Oneplan
Kindly note that all of the above information was provided to the client as the policy documents is sent to the policy holders email address before the inception of the policy. Upon receiving the query, the policy holder was contacted, and a further explanation was provided in line with our policy terms and conditions.
Kind Regards,
Oneplan