From template emails to no feedback at all

On the 22nd August 2017 my husband visited the GP who send him to the day clinic where he had to undergo sugary. Due to time constrain he did not arrange for funds to be loaded for the surgery and paid the bill at day clinic with the understanding that he can claim it back from OnePlan. He however paid for the GP visit with the onecard.

Based on previous experiences we submitted the documentary proof, which included a detailed invoice and proof of payment in the form of a receipt as well as card payment slip to OnePlan on the 25th August 2017 by way of email as uploading on their App is just not possible.

In response the following was send to me in an email: Unfortunately your claim can't be processed as more details are required. Kindly submit a clear copy and/or a detailed account/invoice with a doctor’s stamp for your claim to be processed. Failure to send the detailed documentation will delay the assessing of this claim and/or might result in your claim being rejected. Once we have received the detailed invoice, we will be able to do the final assessment of your claim. Based on policy terms and conditions and standard claim auditing protocols a detailed invoice will be required to validate the invoice/ receipt received your provider. It is required due to: • The invoice and/ or stamp on receipt being unclear; • The invoice and/ or stamp on receipt does not reflect the practice number and/or contact details of the provider; • The stamp is done on a separate paper or at the back of the receipt. To validate a receipt the stamp needs to be on the front page of the receipt/invoice. In the event that your claim are being rejected you will be required to pay back the funds utilised for this claim, together with a R50,00 administration fee. Your, day to day, health cover will remain suspended until such funds are recovered. This means that you will not be able to load funds on your card or be refunded for card claims until the claim was approved or funds are recovered. Note that your policy will not be suspended and you will be able to claim for emergency visits and hospitalisation during the period that your health cover is suspended.

This is clearly a template email as the required documents were attached to my initial email and I therefore responded and requested clarity as to what documents, other than those already provided they require. I must also add that with every PoP send it is a long process because the people at Oneplan seems to not read the emails and/or only open the first page to the attached file, while all information required are contained in the attached pdf file. Further there is also always the threat or in some instances immediate suspension of our policy and we are unable to claim for emergency visits and hospitalization whether you are at wrong or not!

Once again I received a template email that meant nothing to me and left me even more confused - Thank you for your email as we at Oneplan value all interactions with our customers. With regards to your recent enquiry, I do appologize for the miss communication. The claim for the 22 August have been finalized with the invoice.

I therefore responded and asked whether the money will be refunded onto my onecard?

The next day someone else (also a claims consultant) answered with the following template email: Thank you for your email as we at Oneplan value all interactions with our customers. With regards to your recent enquiry, please note that the funds loaded on the 22 August and swiped at the Boksburg Medical center is the funds we provide for all that what was done on the attached invoice. Everything that was done on the attached invoice is covered under your GP cover limit which is the R330 which was loaded on the 22nd of August 2017.

This this argument does not make sense at all and I again enquired as to why these two claims are combined. A third person (claims consultant) responded with: Everything done at the doctors rooms is covered under the day to day benefits up to your stated cover limit.

On the 5th of September I therefore requested that someone, preferably a manager contact me as the ongoing emails just added to the frustration, to no avail.

On the 14th September I once again asked that someone contact me, then almost 10 days lapsed since my email and 21 days since the claim was submitted and still I have no clarity!!!!!