ONEPLAN #Nthabiseng Vega Consultant

Item: Oneplan Insurance
Rating: 1
Author: Laeqa C

we had the most horrible experience lastnight during an emergency, firstly could not get authorization for a casualty emergency had to call numerous times the paperwork sent was incorrect the first time then the second time we had to call in i think we made almost 10 calls on a space of 2.5 hours and yes that how long it took to get seen due to to Oneplan delays. secondly my husband was so ill the dr found Kidney stones he ha dto be admitted so i had to call again for admission, now almost 3 ours at hospital to be told sorry we cant authorise we dont authrise for that kind of admissions you must be having an operation even the DR spoke to the consultant explaining its serious he must be admitted to se the urologist next day so they can decide whether to op or what procedure will be done. we have been with oneplan over 3 years never had to use hospitalization till now and this was what we got... ABSOLUTLY NOTHING ... to be told to send my husband home and if he gets sick through the night to take him to a state hospital. so what the hell have we been paying for all these years. i will be taking this further and canceling my policy never in my life struggled like this . guys in an emergancy after hours oneplan is really not easy to get through what is the use you have 24hr assistance but nobody assists you in time in the full correct manner using you airtime and wasting valuable time with a sick person that needs medical care.....

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Replies (1)

Oneplan Insurance's replyOfficial

18 Nov 2022, 14:31

Good day Laeqa,

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 husband's best interest at heart and wish him a speedy recovery.

As per our telephonic conversation, kindly note that authorization for Casualty Cover was provided last night based on the information the hospital provided us with which included the triage colour.

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.

We grant the authorization based on the information that the hospital provides us with which included the patients clinical and vitals signs, unfortunately an authorization for Admission 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. 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.

Kindly note that diagnostic tests and pain control is a general exclusion under the in-hospital benefit. In order for an Admission authorization to be granted we require the treatment plan from the hospital which will confirm active treatment to treat the confirmed condition and not observation.

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. We do have our client's best interests at heart, and we will assist with all we can in line with our terms and conditions. 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 once we receive the invoices for the Radiology claim, we 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

Oneplan Insurance's reply18 Nov 2022, 14:31

Official

Good day Laeqa,

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 husband's best interest at heart and wish him a speedy recovery.

As per our telephonic conversation, kindly note that authorization for Casualty Cover was provided last night based on the information the hospital provided us with which included the triage colour.