1 reviews | Active since Nov 2013
Rejected hospitalization admission
Absolutely disappointed with one plan after being a customer since 2015!!! My Stryker had gotten injured due to an unforeseen accident and is unable to wal! I called through and spoke to Rutendo ,31/01/2022 informing oneplan of what has happened of which i expected the situation to treated with extreme seriousness and an emergency however i was told they would just load funds of R1300 to see the vet and was informed in the event if the injury needed further attention the vet would be required to complete pet claim form for admission. Upon seeing the vet , she did confirm my worst fear that my boy needs to be admitted ,he needs to be sedated and run the necessary scans to confirm diagnosis of injury. So I acted as soon as possible to get the documents through at approximately 13:05pm to speed up process and have my boy admitted, however I only recieved feedback with an email on Tuesday 01/02/2022 around 13:00pm saying "trust that you are well. We regret to inform you that the pre-authorisation request for Stryker has been rejected. Unfortunately, we cannot grant pre-authorisation for Hospital Admission for diagnostic procedures. Diagnostic procedures are subject to cover under the Casualty Benefit, up to cover limit of R1300 per event and will be assessed as such. Please see extract from Policy Schedule below: 4. ONEPLAN PET HOSPITAL ADMISSION COVER WHAT IS NOT COVERED: 2. Admission and/or hospitalisation exclusively for diagnostic procedures, monitoring and/or observing. In the event that the diagnostic procedures result in a confirmed diagnosis and in hospital treatment plan, the claim can be reassessed as a whole under the Hospital Admission Benefit." My dog is suffering and this is the mail I get?? How can we afford to pay for sedation and scans without admission? Should I even wait for authorization in the event of an emergency?? This is absolutely appalling by oneplan knowing my pet is probably in so much pain! I need answers soon. Time is ticking and my dogs condition is only going to get worse!
Thank you for taking the time to bring this to our attention.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that he has a speedy recovery. Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients.
The Casualty benefit has a cover limit of R1300 and is limited to 4 Casualty benefits per a year. Diagnostics will fall under the Casualty benefit claim, and should the vet bill exceed R1300, unfortunately the client will be liable for the difference as claims are paid up to the respective cover limits.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
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 that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand.
Oneplan
Thank you for taking the time to bring this to our attention.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that he has a speedy recovery. Kindly note terms and conditions of the policy must be adhered to and app**** fairly for all clients.
The Casualty benefit has a cover limit of R1300 and is limited to 4 Casualty benefits per a year. Diagnostics will fall under the Casualty benefit claim, and should the vet bill exceed R1300, unfortunately the client will be liable for the difference as claims are paid up to the respective cover limits.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
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 that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 acknowledged your complaint and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand.
Oneplan