KM
Kabelo M

1 reviews | Active since Nov 2019

05 Aug 2024, 13:25

OnePlan claims

Oneplan will never pay for claims they will always find away to come with pathetic excuse. I was asked to produce results of an optometrist visit. I provide everything they needed an invoice POP that was not enough they wanted results. they don't care about doctor and patient confidentiality. They will make you feel like a ****mer even when you produce everything they require

0
Replies (2)
Oneplan Insurance
Oneplan Insurance's reply05 Aug 2024, 13:54
Official
Dear Kabelo,

Thank you for taking the time to bring this to our attention. 
     
We sincerely apologize for any inconvenience caused and the circumstances under which your Hellopeter posting has reached as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
  
A detailed invoice is required when claiming for day-to-day benefits. The invoice for the Optometry claim will need to include the eye readings, the Patient's name, and the Service date. Should you wish to load funds for another day-to-day claim, we would require for the previous claims to be concluded before loading any further claims. The reason for this is for auditing purposes on our side and to prevent ***** as funds are loaded within 60 seconds onto your Onecard. 

We recognize that patient confidentiality is a significant concern, which is why we requested that you obtain the eye readings and provide them to us. This is a necessary step to allow us to assess and finalize the claim with the necessary information. 

It is important to take note that as per our Policy Terms and Conditions under General Conditions Point 6 states that, You agree to submit to medical examinations at our expense as often as shall be required about any claim after a claim has been accepted. Further, you agree to present on request from us, any documents or other information necessary to enroll the said Insured on the policy and to facilitate ongoing cover or claims processing. 

Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly to all clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. 
  
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand.
         
Once again, we apologize for any inconvenience caused and we hope to restore the experience. 
                  
Kind Regards,
Oneplan 
Oneplan Insurance
Oneplan Insurance's reply05 Aug 2024, 13:55
Official
Dear Kabelo,

Thank you for taking the time to bring this to our attention. 
     
We sincerely apologize for any inconvenience caused and the circumstances under which your Hellopeter posting has reached as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
  
A detailed invoice is required when claiming for day-to-day benefits. The invoice for the Optometry claim will need to include the eye readings, the Patient's name, and the Service date. Should you wish to load funds for another day-to-day claim, we would require for the previous claims to be concluded before loading any further claims. The reason for this is for auditing purposes on our side and to prevent ***** as funds are loaded within 60 seconds onto your Onecard. 

We recognize that patient confidentiality is a significant concern, which is why we requested that you obtain the eye readings and provide them to us. This is a necessary step to allow us to assess and finalize the claim with the necessary information. 

It is important to take note that as per our Policy Terms and Conditions under General Conditions Point 6 states that, You agree to submit to medical examinations at our expense as often as shall be required about any claim after a claim has been accepted. Further, you agree to present on request from us, any documents or other information necessary to enroll the said Insured on the policy and to facilitate ongoing cover or claims processing. 

Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly to all clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. 
  
We have acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand.
         
Once again, we apologize for any inconvenience caused and we hope to restore the experience. 
                  
Kind Regards,
Oneplan