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sharene.wright sharene.wright

1 reviews | Active since May 2017

17 Mar 2021, 16:35

Ok

I do understand that this is health insurance. Day to day is absolutely brilliant, never had any problems, besides me myself submitting incorrect documents, for which when explained, was all sorted and paid for by one plan. Was extremely upset with the hospital insurance fund, which I understand per event, as well as the excess cover. There was no problem with them paying with their event amount. which leaves me angry, as this should have been explained to the Hospital that treatment does not need authorization for any items as long as it is in the set amount, which for me left me in hospital for an extra 4 days thus meaning the funds were depleted, which in fact everything would have been covered perhaps with just a little shortfall which I would have had to pay for. I have spent weeks get letters from the doctors and submitting them to one plan to fall under the dreaded disease ect ect, which was a waste of time as this was not going to happen. It's just been around a run instead of upfront honest with the clients. Besides this incident which has left a bad taste, I have been with one plan for many years and never had a problem before. I really think one plan should also make it very very clear with the hospital's about the set event funds, as they have no idea and just rather blame the bad service, I was ill and could not do this myself at the time of been admitted.

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Replies (1)
Oneplan Insurance
Oneplan Insurance's reply18 Mar 2021, 14:38
Official
Good day Sharene,
 
Thank you for taking the time to bring this to our attention. 

We would like to sincerely apologize for the inconvenience caused. 

Kindly note during a hospital stay continuous communication takes place with clients, beneficiaries and hospital representatives to keep them afloat in terms of cover limits. The Insurer depends on the mentioned entities to convey this information and plan accordingly when it comes to shortfalls. Our records show relatives and the hospital were duly informed of the depleted cover limit, it also remains the responsibility of the client to liaise with hospital case managers to know interim amounts as cover limits are advised when an authorization number is issued.

As per our telephonic conversation dated 2021/03/15, as a medical insurance, our cover or benefits have specific limits applicable. The hospital claim has been approved and paid up to the respective cover limit. The excess buster, on the other hand, is not a gap cover but a fraction/percentage payable to the Insurer. This facility means you do not pay any excess to us when using your in-hospital benefits.
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. 
 
We once again apologize for any inconvenience caused. 
   
Kind Regards,
Oneplan