Disappointed

We joined OnePlan in 2015. At that time we app**** for the Blue Plan because it was all we could afford back then. My husband, who has had type 1 diabetes for 43 years, had to wait the full year before he could claim for anything.

Till recently we had been quite happy on OnePlan and therefore in March 2018 we decided that we could afford an upgrade and contacted OnePlan (all calls are recorded, as they always remind us). We requested that I leave the current plan and join separately on the Core plan, due to the fact that I am never ill and seldom go to the doctor. For my husband, however, we requested that he be upgraded to the Executive Plan which would cover much more than the current Blue plan.

Since then I have been paying the separate premium for my personal cover on the Core plan, and (presumed) that we were paying for the Executive Plan for my husband. Unfortunately, we didn’t check our business bank statement to see what amount was being deducted because it goes through automatically so we didn’t worry about it.

On Tuesday (25 Sept 2018), my husband was admitted to the hospital as an emergency admittance because of a diabetic toe infection that didn’t want to heal. This was being caused by narrowed arteries due to his many years as a diabetic. The doctors wanted to perform angiograms to open up the narrowed arteries. My husband had also gone to the heart specialist because of a pressing chest pain and discomfort (also caused by narrowed arteries).

To our utter dismay, my husband was confronted by a lady from the Mediclinic accounts department (after being admitted) to let him know that our hospital plan will only cover a small portion of the procedures and we would have to pay a huge deposit in order to continue with the procedures. When I contacted OnePlan I was told that he didn’t qualify for more cover on the Blue Plan. I explained that he had upgraded a few months ago to the Executive plan. After checking on their system and calling me back I was informed that the application was done but that the request to upgrade was rejected. We did not receive any correspondence (phone call, letter, email or sms) to inform us of this. We were completely under the impression that my husband was on a better plan in order to received better treatment when needed for his chronic condition.

Due to a sudden critical decline in his health he was admitted for bypass surgery and heart valve replacement in November 2018. The costs for the doctors, ICU, hospital, pathology, physiotherapy, etc, etc. is about R 450 000-00. OnePlan is only covering a portion of this because of his existing cover. We are self-employed and work extremely hard to make an honest living and after having lived with diabetes all his life and not once slowing down because of his condition, I feel that my husband was let down in his hour of need.

I feel that OnePlan could at least have called us to in inform us and explain the reason for rejecting the upgrade application. Then we could have made alternative plans and looked for a better option.

Expected Outcome: All we expect from OnePlan is that my husband be put onto the Executive Plan as originally requested and that his expenses be covered as it would have been had the upgrade been done. We are more than willing to pay the arrears and bring the policy up to date.