WTFS
Wendi Taute Fitzhenry Skowronek
1 reviews | Active since Oct 2020
14 May 2021, 11:24
FALSE ADVERTISING - BEWARE
BEWARE THEY ARE QUICK TO SELL YOU THE POLICY BUT WHATS THE POINT IF YOU HAVE TO BE ADMITTED TO STATE HOSPITALS! I took out one plan heath insurance for my son in June 2020. He has NOT claimed anything to date but had to be hospitalised Saturday with stomach pains. One Plan Would NOT pay for a private hospital and also not for the DOCTOR that attended to him at the state hospital!!!!! he had kidney stones and upon me checking with them they just responded with: its not covered and neither is A private hospital!
Helpful (0)
Replies (1)0
Replies (1)
Oneplan Insurance's replyOfficial
16 May 2021, 15:37Good day Wendi,
Thank you for taking the time to bring this to our attention.
We are sorry to hear of the circumstances under which your Hellopeter posting has reached us and we do apologize for the inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your sons best interests at heart.
Our claims department attempted to contact you, however it was to no avail.
Upon investigation we have identified that the ER called us on 8th May 2021, as they wanted to transfer your son to a private hospital since he was already at a State facility. The ER was notified of the waiting period and the exclusion.
Kindly not as per our policy schedule there is a 12-month waiting period for Kidney stones and removal of kidney stones and bladder / urethra surgery, including cystoscopies \ and circumcisions. Unfortunately, the claim was rejected due to condition that is excluded for the first twelve months of the policy.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. 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 once again apologize for all that you have been through.
Thank you for taking the time to bring this to our attention.
We are sorry to hear of the circumstances under which your Hellopeter posting has reached us and we do apologize for the inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your sons best interests at heart.
Our claims department attempted to contact you, however it was to no avail.
Upon investigation we have identified that the ER called us on 8th May 2021, as they wanted to transfer your son to a private hospital since he was already at a State facility. The ER was notified of the waiting period and the exclusion.
Kindly not as per our policy schedule there is a 12-month waiting period for Kidney stones and removal of kidney stones and bladder / urethra surgery, including cystoscopies \ and circumcisions. Unfortunately, the claim was rejected due to condition that is excluded for the first twelve months of the policy.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. 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 once again apologize for all that you have been through.
Kind Regards,
Oneplan
Oneplan Insurance's reply16 May 2021, 15:37
Official
Good day Wendi,
Thank you for taking the time to bring this to our attention.
We are sorry to hear of the circumstances under which your Hellopeter posting has reached us and we do apologize for the inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your sons best interests at heart.
Our claims department attempted to contact you, however it was to no avail.
Upon investigation we have identified that the ER called us on 8th May 2021, as they wanted to transfer your son to a private hospital since he was already at a State facility. The ER was notified of the waiting period and the exclusion.
Kindly not as per our policy schedule there is a 12-month waiting period for Kidney stones and removal of kidney stones and bladder / urethra surgery, including cystoscopies \ and circumcisions. Unfortunately, the claim was rejected due to condition that is excluded for the first twelve months of the policy.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. 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 once again apologize for all that you have been through.
Thank you for taking the time to bring this to our attention.
We are sorry to hear of the circumstances under which your Hellopeter posting has reached us and we do apologize for the inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your sons best interests at heart.
Our claims department attempted to contact you, however it was to no avail.
Upon investigation we have identified that the ER called us on 8th May 2021, as they wanted to transfer your son to a private hospital since he was already at a State facility. The ER was notified of the waiting period and the exclusion.
Kindly not as per our policy schedule there is a 12-month waiting period for Kidney stones and removal of kidney stones and bladder / urethra surgery, including cystoscopies \ and circumcisions. Unfortunately, the claim was rejected due to condition that is excluded for the first twelve months of the policy.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. 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 once again apologize for all that you have been through.
Kind Regards,
Oneplan