I went to the hospital because I couldn't walk and had abdominal pain

Dear Khodani, 

We acknowledge receipt of your concerns and regret the inconvenience and dissatisfaction caused. Please be assured that this experience does not reflect the standard of service we strive to uphold. 

Your claim has undergone a thorough and detailed review, and we would like to clarify the outcome as follows:

Following careful assessment of the information available, your claim was declined based on the reason for admission, the provider’s (hospital) triage classification (yellow), as well as the applicable policy terms and conditions. A yellow triage classification indicates that the condition requires medical attention but is not considered life-threatening.

In terms of your policy, cover for emergency or casualty visits is limited to conditions deemed life-threatening. As the clinical information provided did not meet this criterion, the claim could not be approved. It is important to note that, should the casualty visit have resulted in a confirmed diagnosis of a serious condition requiring immediate medical intervention, the claim would be subject to review for possible consideration in line with the policy provisions. 

The formal repudiation letter detailing the outcome has been issued to your registered email address. 

We further emphasise that all cover is governed by the terms and conditions outlined in your policy documentation, which are provided at inception and remain applicable throughout the duration of the policy. We encourage you to review your policy schedule to ensure a clear understanding of your benefits, limits, and applicable conditions. 

While we understand that this outcome may not be favourable, we trust that the above provides clarity regarding the decision reached. 

Kind regards, 
Oneplan.