AC
Arina C
1 reviews | Active since Feb 2012
25 Jan 2023, 10:48
Poor Service
Im very unhappy about the service I have received this morning. My partner was consulting with a specialist yesterday and advised she must be admitted with Acute Abdomen at Mediclinic Potchefstroom this morning. I have phoned and booked a bed and was advised that they need a GOP so I must phone and get that in the meantime.. So I have spoke to a consultant this morning and HE said over the phone the ICD10 was rejected previously but the fact is she was never admitted for this condition so how can this be a exclusion for the next 12 months?? Then he said furthermore that because she has endometriosis it can be related to this cause? Is he a Doctor? This is the poorest service I have ever received from and medical and Im actually working with all of the medical aids everyday. You want money every month but cant help when your clients when its actually necessary. I dont care what you gonna do this patient needs to be admitted today.
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Arina C's updateReviewer Update
25 Jan 2023, 13:42I have phoned *** 5 hours ago and ask the consultant for the manager to please call me back urgently!!!! Its almost 14:00 and still no reply! YOU are playing with your "patients" health!
AC
Arina C's update25 Jan 2023, 13:42
Reviewer Update
I have phoned *** 5 hours ago and ask the consultant for the manager to please call me back urgently!!!! Its almost 14:00 and still no reply! YOU are playing with your "patients" health!
Oneplan Insurance's replyOfficial
25 Jan 2023, 16:15Good day Arina,
Thank you for taking our call earlier and for advising us on the additional documentation.
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.
Kindly note that diagnostic tests/investigations 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 or diagnosis. Each approved admission/event must have either confirmed diagnostic reports or alternatively a treatment plan with symptoms. For us to assist a funding decision can only be given based on the information provided by the hospital.
As per your policy schedule under the heading Illness in Hospital, Special Conditions it states that Ulcers, gastritis, GERD, diverticulitis, irritable bowel syndrome, ****** bleeding or gastrointestinal bleeding and associated gastroscopies, colonoscopies and sigmoidoscopies are excluded for a period of twelve (12) months from date of inception. Your policy inception date is the 01st of July 2022. Please take note that the General Exclusions on your policy documents confirms that we will not be liable for expenses, hospitalization, injury, sickness or disease directly or indirectly caused by or related to admission to a medical facility/hospital for investigative purposes and/or pain control.
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 your partners 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.
We have since proceeded to send an email to your listed email address with detailed feedback based on the information that we received.
We once again apologize for all that you have been through.
Kind Regards,
Oneplan
Thank you for taking our call earlier and for advising us on the additional documentation.
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.
Kindly note that diagnostic tests/investigations 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 or diagnosis. Each approved admission/event must have either confirmed diagnostic reports or alternatively a treatment plan with symptoms. For us to assist a funding decision can only be given based on the information provided by the hospital.
As per your policy schedule under the heading Illness in Hospital, Special Conditions it states that Ulcers, gastritis, GERD, diverticulitis, irritable bowel syndrome, ****** bleeding or gastrointestinal bleeding and associated gastroscopies, colonoscopies and sigmoidoscopies are excluded for a period of twelve (12) months from date of inception. Your policy inception date is the 01st of July 2022. Please take note that the General Exclusions on your policy documents confirms that we will not be liable for expenses, hospitalization, injury, sickness or disease directly or indirectly caused by or related to admission to a medical facility/hospital for investigative purposes and/or pain control.
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 your partners 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.
We have since proceeded to send an email to your listed email address with detailed feedback based on the information that we received.
We once again apologize for all that you have been through.
Kind Regards,
Oneplan
Oneplan Insurance's reply25 Jan 2023, 16:15
Official
Good day Arina,
Thank you for taking our call earlier and for advising us on the additional documentation.
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.
Kindly note that diagnostic tests/investigations 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 or diagnosis. Each approved admission/event must have either confirmed diagnostic reports or alternatively a treatment plan with symptoms. For us to assist a funding decision can only be given based on the information provided by the hospital.
As per your policy schedule under the heading Illness in Hospital, Special Conditions it states that Ulcers, gastritis, GERD, diverticulitis, irritable bowel syndrome, ****** bleeding or gastrointestinal bleeding and associated gastroscopies, colonoscopies and sigmoidoscopies are excluded for a period of twelve (12) months from date of inception. Your policy inception date is the 01st of July 2022. Please take note that the General Exclusions on your policy documents confirms that we will not be liable for expenses, hospitalization, injury, sickness or disease directly or indirectly caused by or related to admission to a medical facility/hospital for investigative purposes and/or pain control.
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 your partners 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.
We have since proceeded to send an email to your listed email address with detailed feedback based on the information that we received.
We once again apologize for all that you have been through.
Kind Regards,
Oneplan
Thank you for taking our call earlier and for advising us on the additional documentation.
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.
Kindly note that diagnostic tests/investigations 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 or diagnosis. Each approved admission/event must have either confirmed diagnostic reports or alternatively a treatment plan with symptoms. For us to assist a funding decision can only be given based on the information provided by the hospital.
As per your policy schedule under the heading Illness in Hospital, Special Conditions it states that Ulcers, gastritis, GERD, diverticulitis, irritable bowel syndrome, ****** bleeding or gastrointestinal bleeding and associated gastroscopies, colonoscopies and sigmoidoscopies are excluded for a period of twelve (12) months from date of inception. Your policy inception date is the 01st of July 2022. Please take note that the General Exclusions on your policy documents confirms that we will not be liable for expenses, hospitalization, injury, sickness or disease directly or indirectly caused by or related to admission to a medical facility/hospital for investigative purposes and/or pain control.
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 your partners 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.
We have since proceeded to send an email to your listed email address with detailed feedback based on the information that we received.
We once again apologize for all that you have been through.
Kind Regards,
Oneplan