1 reviews | Active since Jul 2016
Poor service and promises.Dissapointed
My mom was sent home to die in an emergency last night..In the whole of South Africa one person had the authorisation right, no management,no supervisor available.My mom had an emergency and one plan sent her home in her case after admission. Please advise "Oneplan Health Insurance does a person have to wait for more than a year for emergency medical attention that is not Pre existing."We are talking about a 60 year old that was in need of medical attention.An emergency.Nthabiseng declined casualty on the first call Then another call was made Kholeka issued the code on a second call.Then my mom was admitted a call was made again and Nthabiseng answered she declined that authorisation.Pleass make this make sense to me.As the payer Nthabiseng instructed me to get my mom off the hospital bed to give consent so Nthabiseng could speak to me and mind you I was now phoning from the hospital land line after holding for hours when phoning with my cellphone. My mom has never even been to a GP and I have paid with no fail regardless.When she asked Nthabiseng if she should go back home to die in an emergency at casualty the answer was practically yes.All Nthabiseng could send me was a complaint form.I am hurt more than anything to see my mother leave casualty in a wheelchair to go back home in that condition.Please make this make sense to me.If anything happens to my mother I will hold one plan liable.
Thank you for taking the time to bring this matter to our attention.
We are sorry to hear of the circumstances under which your posting has reached us and we do apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
We have acknowledged your complaint, and have escalated it to the relevant department to be addressed.
Please note the following; the casualty authorisation was granted based on the multiple symptoms presented at the time of arriving at the Casualty Department. However, following casualty treatment, the final diagnosis and primary reason for admission was linked to a pre-existing condition, which is excluded from cover for a period of 12 months in terms of the policy. In addition, the condition also falls within the list of specified conditions that are subject to a general 12-month exclusion period, regardless of whether pre-existing or not.
The pre-authorisation process is solely intended to validate the policy and confirm the benefits available. It does not influence whether treatment may be provided. While every effort is made to assist where possible, policy terms are standardised and cannot be amended.
Kindly note that the formal repudiation letter regarding this has been sent to the listed email address. Concerns regarding policy terms and conditions are escalated to the Complaints Department for review, in accordance with the Complaints Resolution Policy.
Once again, we apologize for any inconvenience caused and hope this provides more clarity on the processing of the claim.
Kind Regards,
Oneplan.
Thank you for taking the time to bring this matter to our attention.
We are sorry to hear of the circumstances under which your posting has reached us and we do apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
We have acknowledged your complaint, and have escalated it to the relevant department to be addressed.
Please note the following; the casualty authorisation was granted based on the multiple symptoms presented at the time of arriving at the Casualty Department. However, following casualty treatment, the final diagnosis and primary reason for admission was linked to a pre-existing condition, which is excluded from cover for a period of 12 months in terms of the policy. In addition, the condition also falls within the list of specified conditions that are subject to a general 12-month exclusion period, regardless of whether pre-existing or not.
The pre-authorisation process is solely intended to validate the policy and confirm the benefits available. It does not influence whether treatment may be provided. While every effort is made to assist where possible, policy terms are standardised and cannot be amended.
Kindly note that the formal repudiation letter regarding this has been sent to the listed email address. Concerns regarding policy terms and conditions are escalated to the Complaints Department for review, in accordance with the Complaints Resolution Policy.
Once again, we apologize for any inconvenience caused and hope this provides more clarity on the processing of the claim.
Kind Regards,
Oneplan.