1 reviews | Active since Oct 2022
Oneplan is Useless
Having Oneplan is useless. I have had many bad experiences with them. I would find myself sending receipts over and over again for my refund. Recently I had a medical emergency, my 10 year old son had ****** urine as in a lot of blood. I called for authorisation for emergency room. The guy that assisted me told me that I can go to ER but at my own discretion. They can only authorise ER benefit if it's a life threatening emergency as to which I can decide whether or not I want to take that chance of having a huge bill if they don't pay or don't find it life threatening enough. I decided against it and bought my son some medication to get through the night. The next day I took him to see the GP...after examining him she thought it's best if we did some blood tests. I paid for these in cash since it's a rural area they use cash envelopes to receive the payment for blood tests. I took a picture of the cash envelope because I had anticipated they would want proof of payment. The cash envelope is exactly the same format as an invoice/receipt. I called up the lab after and requested them to send me a statement or invoice for the bloods to submit to oneplan for a refund. After a few days the lab sent me the required documents. I sent these to Oneplan via WhatsApp via email and via the app. They reviewed the statement and asked for a detailed invoice to prove I had paid for the blood. I sent them the picture of the cash envelope. I get a message saying the claim is rejected because of absence of detailed invoice showing I paid for the blood work. I mean what more do they want. The statement from the lab had my son and my details as a guarantor. The test done and their prices were listed as well as the payment I made. But no...this was not detailed enough. The cash envelope had the same details and matched the statement, still not detailed enough. So basically every time a need medical attention I end up paying out of pocket because oneplan is useless and very *****.
Thank you for taking our call earlier and allowing us the opportunity to further discuss the matter at hand.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your son's best interest at heart and wish that he is having a speedy recovery.
As per our telephonic conversation, kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
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 for all clients. 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.
As per our discussion we are currently dealing with the pathology claim and will revert to you with the relevant feedback.
Once again, we apologize for the inconvenience caused and we hope to restore the experience.
Kind Regards,
Oneplan
Best regards,
Thank you for taking our call earlier and allowing us the opportunity to further discuss the matter at hand.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your son's best interest at heart and wish that he is having a speedy recovery.
As per our telephonic conversation, kindly note that the “Casualty Cover” means emergency treatments which cannot wait for a normal consultation at the doctor, you may go to the nearest hospital casualty unit, where we will cover you should the emergency be confirmed as a triage category Orange or Red.
When the hospital contacts us, they will inform us on the triage category that the patient is currently on. “Triage” means assessing of emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
The authorization is provided based on the information that the hospital provides us with, unfortunately an authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at hospital.
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 for all clients. 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.
As per our discussion we are currently dealing with the pathology claim and will revert to you with the relevant feedback.
Once again, we apologize for the inconvenience caused and we hope to restore the experience.
Kind Regards,
Oneplan
Best regards,