Disgusting Service from Oneplan

On the 25/11/2020 my father was referred by a general practitioner to a specialist surgeon, with a 2 week history of developing obstructive jaundice. At the time, he was unwell, with persistent nausea and vomiting and has not eaten for a few days. suggested to get Dad hospitalized for IV fluids and antibiotics and to ascertain the cause of his illness. After consulting with a very *********** and rude Mr Denzil Govender, the admission authorization was declined by him as he felt the admission was for investigation purposes only. My father returned home sick continuously vomiting. When my sister , who is a qualified medical Doctor intervened with Oneplan by sending them his liver function test results and spoke to another consultant , did they approve the authorization and he was admitted into hospital the next day.

He eventually had a CT scan, which was followed by an MRCP where a radiological diagnoses (cancer of the bile duct) was made. After meeting with previously mentioned Specialist , we were informed that the way forward is to perform a Whipple’s procedure to remove the cancer. We were informed histology was not possible beforehand as one would require usually before major surgery as it can complicate the surgery and my fathers’ condition. As this is a major procedure, we seeked advice and a second opinion from another Specialist , who is a hepatobi****y-pancreatic surgeon . He met with us and advised he will review all the radiological images with a panel of surgeons and advise us further. On the 3/12/2020 he confirmed that this is a cancer of the bile duct, therefore the operation was the best way forward and they cannot do a biopsy first as this is not the correct medical management of cholangiocarcinoma and a delay in surgery could have drastic consequences including spreading of the cancer. It is still possible to remove and the new specialist sent through a motivation letter confirming the diagnoses which was made based on multiple reviews by many specialists on radiological images. After the motivation confirming the cancer diagnoses, Mr Denzil Govender rejected the claim and said they want the histology report after the operation and the will grant the Dread disease cover which is R275 000. Please note, my sister spoke to Mr Denzil Govender on 3rd December between 3:30 – 4:30 ( Check your calls), and he confirmed he will need to send through a motivation to a review panel to assess the claim. My sister, emailed numerous requests asking for a consultant to please forward information to a physician to review all the information as my father requires the surgery urgently and the hospital need R350000 upfront or an authorization number. All requests were ignored and all the consultants rep**** by saying they need histology. No medical professional was involved in this decision.

So the issue is the Hospital wanted R350 000 to do the operation and Oneplan did not want to give assurance of dread disease cover despite a confirmed diagnoses of cholangiocarcinoma and a letter from a Hepatobi****y specialist surgeon confirming it. A histology is not always possible with diagnoses of cancer and as physicians, at times we have to use the special features and trained radiologists to confirm a diagnoses with imaging. It would be ********* for any surgeon to proceed with such a major operation if they are not convinced it is a cancer. Fortunately, we were by the means to access an emergency loan from the Bank of R350 000 to admit my father so they can urgently do the operation because he was getting worse by the day. We are complaining as it is not easy to come up with such a large amount of money within a day. We feel there was no discussion with medical professionals and if we could not come up with the money, our father would not have lived much longer. A few weeks at most. Are these decisions that consultants over the telephone can make? Risking patients’ lives.

Then secondly we provided 17th of December 2020 with proof of cancer, Whereby on the 18th Oneplan requested a Proof of payment to the hospital which we provided on the same day.

When we followed up on the 22 December on how far the payment is, as we still have to pay in the money not covered, Denzil Govender said he did not receive a proof of Payment, which was attached in the email. ( we have all the emails)

We are so under stress, my Dad is recovering very slowly, and we are really finding no joy with Oneplan who has been taking our money for almost 10 years, with almost zero claims on my dads record.

We called today to speak to a person in higher authority and the call center refused to put us through.

Totally Disgusting!!!