SL
Sonja L
1 reviews | Active since Mar 2009
22 Apr 2025, 21:48
Refusal to authorize hospital admissiin for serious bodily harm of patient
I signed my sister up on the Oneplan Blue plan in 2020 with policy number ***. I am the payer of the policy. My sister was admitted by a doctor on 22 April 2025 to the Alberton Hospital but Oneplan refuse to authorize the admission. She is in extreme pain and Oneplan said tonight, "it must be life or death before you can use the illness in hospital benefits". This is clearly an excuse and goes against why the illness benefit exists. Why did they pay for skin lesiins to be removed but not when the patient is in extreme pain.
This needs to be urgently reviewed by COB 23 April 2025 else I will escalate it to the Ombudsnan for false advertising and unfair treatment. I hereby hold Oneplan responsible for the pain, suffering and possible death of my sister.
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Replies (6)0
Replies (6)
Oneplan Insurance's replyOfficial
23 Apr 2025, 07:00Dear Sonja,
Thank you for bringing this matter to our attention.
We regret the inconvenience you have experienced and the circumstances that led to your Hellopeter review. Please be assured that we take client feedback seriously, as it helps us refine our processes and uphold the service standards we aim to provide.
As Oneplan we are deeply sorry to hear about your sister’s condition and the distress this situation has caused your family. Please know that we take matters like this extremely seriously.
Thank you for bringing this matter to our attention.
We regret the inconvenience you have experienced and the circumstances that led to your Hellopeter review. Please be assured that we take client feedback seriously, as it helps us refine our processes and uphold the service standards we aim to provide.
As Oneplan we are deeply sorry to hear about your sister’s condition and the distress this situation has caused your family. Please know that we take matters like this extremely seriously.
We understand your frustration and concern regarding the hospital admission and the application of the illness benefit. While our policies and procedures are in place to guide medical cover, we recognize that each case involves real people and urgent needs. Your feedback highlights a situation that clearly needs urgent review.
Kindly allow us to investigate this matter further and escalate it immediately to the relevant department for urgent attention. We will get back to you as soon as possible with feedback.
Your patience is greatly appreciated, and we are committed to ensuring this is addressed promptly and with the seriousness it deserves.
Kind regards
Oneplan.
Kind regards
Oneplan.
Oneplan Insurance's reply23 Apr 2025, 07:00
Official
Dear Sonja,
Thank you for bringing this matter to our attention.
We regret the inconvenience you have experienced and the circumstances that led to your Hellopeter review. Please be assured that we take client feedback seriously, as it helps us refine our processes and uphold the service standards we aim to provide.
As Oneplan we are deeply sorry to hear about your sister’s condition and the distress this situation has caused your family. Please know that we take matters like this extremely seriously.
Thank you for bringing this matter to our attention.
We regret the inconvenience you have experienced and the circumstances that led to your Hellopeter review. Please be assured that we take client feedback seriously, as it helps us refine our processes and uphold the service standards we aim to provide.
As Oneplan we are deeply sorry to hear about your sister’s condition and the distress this situation has caused your family. Please know that we take matters like this extremely seriously.
We understand your frustration and concern regarding the hospital admission and the application of the illness benefit. While our policies and procedures are in place to guide medical cover, we recognize that each case involves real people and urgent needs. Your feedback highlights a situation that clearly needs urgent review.
Kindly allow us to investigate this matter further and escalate it immediately to the relevant department for urgent attention. We will get back to you as soon as possible with feedback.
Your patience is greatly appreciated, and we are committed to ensuring this is addressed promptly and with the seriousness it deserves.
Kind regards
Oneplan.
Kind regards
Oneplan.
Oneplan Insurance's replyOfficial
23 Apr 2025, 11:00Dear Sonja,
Thank you for your recent query regarding the Casualty Benefit. We would like to take this opportunity to clarify how this benefit is app****.
Thank you for your recent query regarding the Casualty Benefit. We would like to take this opportunity to clarify how this benefit is app****.
The Casualty Benefit is specifically intended to provide cover for events that are assessed as life-threatening. In making this assessment (Triage), we consider several factors, including the symptoms experienced, their duration and severity (acuteness), as well as any associated medical conditions.
If the initial assessment does not indicate that the event is life-threatening, the related costs will be covered under your Day-to-Day Benefits. This includes consultations with a general practitioner, prescribed medication, and diagnostic services such as radiology or pathology.
Should the condition change or deteriorate, and the treating medical practitioner confirms it as serious or life-threatening, we will reassess the case and consider cover under the Casualty Benefit accordingly.
We fully understand that medical events can be extremely stressful, and we are here to support you throughout. However, it is essential that benefits are managed in accordance with the terms and conditions of the policy to ensure fairness and sustainability for all members.
If you have any further questions or need additional assistance, please don’t hesitate to reach out.
Kind regards
Oneplan.
If you have any further questions or need additional assistance, please don’t hesitate to reach out.
Kind regards
Oneplan.
Oneplan Insurance's reply23 Apr 2025, 11:00
Official
Dear Sonja,
Thank you for your recent query regarding the Casualty Benefit. We would like to take this opportunity to clarify how this benefit is app****.
Thank you for your recent query regarding the Casualty Benefit. We would like to take this opportunity to clarify how this benefit is app****.
The Casualty Benefit is specifically intended to provide cover for events that are assessed as life-threatening. In making this assessment (Triage), we consider several factors, including the symptoms experienced, their duration and severity (acuteness), as well as any associated medical conditions.
If the initial assessment does not indicate that the event is life-threatening, the related costs will be covered under your Day-to-Day Benefits. This includes consultations with a general practitioner, prescribed medication, and diagnostic services such as radiology or pathology.
Should the condition change or deteriorate, and the treating medical practitioner confirms it as serious or life-threatening, we will reassess the case and consider cover under the Casualty Benefit accordingly.
We fully understand that medical events can be extremely stressful, and we are here to support you throughout. However, it is essential that benefits are managed in accordance with the terms and conditions of the policy to ensure fairness and sustainability for all members.
If you have any further questions or need additional assistance, please don’t hesitate to reach out.
Kind regards
Oneplan.
If you have any further questions or need additional assistance, please don’t hesitate to reach out.
Kind regards
Oneplan.
SL
Sonja L's updateReviewer Update
23 Apr 2025, 11:34ONEPLAN HAS BECOME MINDREADERS AND MAKE UNFAIR AND ********* DECISION BASED ON NO MEDICAL EVIDENCE
Hi
The Illness Casualty event should be dealt with once admitted for review in the casualty department. How would you know its life threatening if you do not allow the illness casaulty event to commence?? Sucking the answer out of the air and making a decision is unfair, ********* and biased.
The treating doctor ADMITTED my sister into hospital due to your illness casualty making a determination upfront that its not life threatening without medical investigation. THIS TOO was declined as not being life threatening. OnePlan seriously need to go into the crystal ball environment as they can determine upfront without seeing a patient nor getting medical reviews by examining the patient that its not life threatening. How does Oneplan determine a heart attack or a stroke? Once the person has died?
KINDLY CONFIRM WHY ONEPLAN ADMITTED MY SISTER TWICE FOR HER SKIN LESIONS IF IT WAS NOT A LIFE THREATING EVENT
I need your response to my complaint emailed to myself so sonja dot laubscher at gmail dot com with your reference number as I will be escalating this to the Ombudsman and I will be taking legal action in the event that something happens to my sister or in the event that she dies due to the conduct of OnePlan.
Hi
The Illness Casualty event should be dealt with once admitted for review in the casualty department. How would you know its life threatening if you do not allow the illness casaulty event to commence?? Sucking the answer out of the air and making a decision is unfair, ********* and biased.
The treating doctor ADMITTED my sister into hospital due to your illness casualty making a determination upfront that its not life threatening without medical investigation. THIS TOO was declined as not being life threatening. OnePlan seriously need to go into the crystal ball environment as they can determine upfront without seeing a patient nor getting medical reviews by examining the patient that its not life threatening. How does Oneplan determine a heart attack or a stroke? Once the person has died?
KINDLY CONFIRM WHY ONEPLAN ADMITTED MY SISTER TWICE FOR HER SKIN LESIONS IF IT WAS NOT A LIFE THREATING EVENT
I need your response to my complaint emailed to myself so sonja dot laubscher at gmail dot com with your reference number as I will be escalating this to the Ombudsman and I will be taking legal action in the event that something happens to my sister or in the event that she dies due to the conduct of OnePlan.
SL
Sonja L's update23 Apr 2025, 11:34
Reviewer Update
ONEPLAN HAS BECOME MINDREADERS AND MAKE UNFAIR AND ********* DECISION BASED ON NO MEDICAL EVIDENCE
Hi
The Illness Casualty event should be dealt with once admitted for review in the casualty department. How would you know its life threatening if you do not allow the illness casaulty event to commence?? Sucking the answer out of the air and making a decision is unfair, ********* and biased.
The treating doctor ADMITTED my sister into hospital due to your illness casualty making a determination upfront that its not life threatening without medical investigation. THIS TOO was declined as not being life threatening. OnePlan seriously need to go into the crystal ball environment as they can determine upfront without seeing a patient nor getting medical reviews by examining the patient that its not life threatening. How does Oneplan determine a heart attack or a stroke? Once the person has died?
KINDLY CONFIRM WHY ONEPLAN ADMITTED MY SISTER TWICE FOR HER SKIN LESIONS IF IT WAS NOT A LIFE THREATING EVENT
I need your response to my complaint emailed to myself so sonja dot laubscher at gmail dot com with your reference number as I will be escalating this to the Ombudsman and I will be taking legal action in the event that something happens to my sister or in the event that she dies due to the conduct of OnePlan.
Hi
The Illness Casualty event should be dealt with once admitted for review in the casualty department. How would you know its life threatening if you do not allow the illness casaulty event to commence?? Sucking the answer out of the air and making a decision is unfair, ********* and biased.
The treating doctor ADMITTED my sister into hospital due to your illness casualty making a determination upfront that its not life threatening without medical investigation. THIS TOO was declined as not being life threatening. OnePlan seriously need to go into the crystal ball environment as they can determine upfront without seeing a patient nor getting medical reviews by examining the patient that its not life threatening. How does Oneplan determine a heart attack or a stroke? Once the person has died?
KINDLY CONFIRM WHY ONEPLAN ADMITTED MY SISTER TWICE FOR HER SKIN LESIONS IF IT WAS NOT A LIFE THREATING EVENT
I need your response to my complaint emailed to myself so sonja dot laubscher at gmail dot com with your reference number as I will be escalating this to the Ombudsman and I will be taking legal action in the event that something happens to my sister or in the event that she dies due to the conduct of OnePlan.
SL
Sonja L's updateReviewer Update
23 Apr 2025, 15:42OnePlan is missing the plot. We are talking about two things.
1) illness casualty
2) hospital illness benefit
You rejected 1) but never sent me the rejection letter with the reasons for rejecting 2) whereas it was the doctor's recommendation to just admit the patient
1) illness casualty
2) hospital illness benefit
You rejected 1) but never sent me the rejection letter with the reasons for rejecting 2) whereas it was the doctor's recommendation to just admit the patient
SL
Sonja L's update23 Apr 2025, 15:42
Reviewer Update
OnePlan is missing the plot. We are talking about two things.
1) illness casualty
2) hospital illness benefit
You rejected 1) but never sent me the rejection letter with the reasons for rejecting 2) whereas it was the doctor's recommendation to just admit the patient
1) illness casualty
2) hospital illness benefit
You rejected 1) but never sent me the rejection letter with the reasons for rejecting 2) whereas it was the doctor's recommendation to just admit the patient
Oneplan Insurance's replyOfficial
24 Apr 2025, 10:13Dear Sonja,
Thank you for your response. However, I must clarify that the information provided is not accurate.
Thank you for your response. However, I must clarify that the information provided is not accurate.
Firstly, triage is not conducted by Oneplan. This is a clinical function performed by the casualty doctor or nurse at the hospital. We do not determine or influence triage decisions. Our obligation is to honour claims based on the information received from the medical professional attending to the patient. Where the treating doctor or nurse confirms that the condition is life-threatening, we proceed with payment in accordance with the triage levels defined in our policy wording.
Secondly, our staff are not authorised to make clinical decisions or override medical assessments. We are a risk underwriting business, and our claims assessments rely strictly on the medical evidence and diagnosis provided by the hospital, doctor, or nurse.
Lastly, it’s important to note that we do not withhold or delay treatment. The treating doctor is responsible for the patient's care, and clients are expected to follow medical advice. Our role is limited to processing payment in line with the policy. Should a doctor advise hospital admission, the client must comply. Not doing so may be viewed as negligence, and such decisions lie entirely with the medical professionals involved. If they cannot self-fund they may approach any public facility to assist.
We have emailed our personal response to the nominated email address on the policy.
Should you need any further assistance, please let us know.
Kind regards
Oneplan.
We have emailed our personal response to the nominated email address on the policy.
Should you need any further assistance, please let us know.
Kind regards
Oneplan.
Oneplan Insurance's reply24 Apr 2025, 10:13
Official
Dear Sonja,
Thank you for your response. However, I must clarify that the information provided is not accurate.
Thank you for your response. However, I must clarify that the information provided is not accurate.
Firstly, triage is not conducted by Oneplan. This is a clinical function performed by the casualty doctor or nurse at the hospital. We do not determine or influence triage decisions. Our obligation is to honour claims based on the information received from the medical professional attending to the patient. Where the treating doctor or nurse confirms that the condition is life-threatening, we proceed with payment in accordance with the triage levels defined in our policy wording.
Secondly, our staff are not authorised to make clinical decisions or override medical assessments. We are a risk underwriting business, and our claims assessments rely strictly on the medical evidence and diagnosis provided by the hospital, doctor, or nurse.
Lastly, it’s important to note that we do not withhold or delay treatment. The treating doctor is responsible for the patient's care, and clients are expected to follow medical advice. Our role is limited to processing payment in line with the policy. Should a doctor advise hospital admission, the client must comply. Not doing so may be viewed as negligence, and such decisions lie entirely with the medical professionals involved. If they cannot self-fund they may approach any public facility to assist.
We have emailed our personal response to the nominated email address on the policy.
Should you need any further assistance, please let us know.
Kind regards
Oneplan.
We have emailed our personal response to the nominated email address on the policy.
Should you need any further assistance, please let us know.
Kind regards
Oneplan.
SL
Sonja L's updateReviewer Update
25 Apr 2025, 11:14OnePlan is being paid for the patient to use the in-hospital illness benefit yet you refuse authorization and still have not sent your rejection letter so it can be escalated for investigation by regulatory parties. To review: "Should a doctor advise hospital admission, the client must comply. Not doing so may be viewed as negligence," - Yes, Oneplan is negligent in not authorizing the admission authorization and refuse to provide a rejection letter for escalation. Kindly provide the underwriters details to lodge a complaint with them as well.
SL
Sonja L's update25 Apr 2025, 11:14
Reviewer Update
OnePlan is being paid for the patient to use the in-hospital illness benefit yet you refuse authorization and still have not sent your rejection letter so it can be escalated for investigation by regulatory parties. To review: "Should a doctor advise hospital admission, the client must comply. Not doing so may be viewed as negligence," - Yes, Oneplan is negligent in not authorizing the admission authorization and refuse to provide a rejection letter for escalation. Kindly provide the underwriters details to lodge a complaint with them as well.