Terrible Service - waiting 2 and a half months for settlement of claim.

Policy number ********** 38 The above mentioned policy is in the name of my dad. I have full POA on this policy. My dad needs to go for treatment every 3 months. On 12 September I requested authorisation for his treatment in September. Authorisation number received was ********** . On 29 September I submitted all his claims. Each claim was submitted on a separate mail and I clearly indicated on each mail what the claim was for, whether is was to be claimed under out of hospital or in hospital/dreaded disease benefit, what the pre auth reference number was and whether the claim must be paid to my father's bank account or settled with the provider. I ensure that there were no confusion on any of the claims. Some out of hospital claims were settled within the 7 days turn around time. No payment was received for the claims done under the dreaded diseases policy. I followed up with the call centre in the week from 13-17 November, who informed me that the claim from the Oncologist were not processed as they did not receive it. on my insistence that it was submitted, she later found the claim, and informed me that we now have to wait 30 days for the claim to be settled. The claim for the treatment medication from Dischem was processed as an out of hospital claim despite my cover email. This will be reprocessed correctly, but will also take 30 days to settle. I insisted to speak to a team leader, as we were not prepared to wait a further 30 days because Oneplan made a mistake. The claims were all submitted on the 29th. I was transferred to Kgomotso Kgosana, who promised he will escalate the claim with the correct department, and he also promised to review all other claim submitted to ensure they were processed correctly, and if there were any other outstanding claims he would escalate these as well. I tried to follow up with him on the 20th of November. He did not return my call. I tried to follow up again on the 21st, no response either. On the 22nd I received the following mail from him: Hi, Please note that I have tried to call you but it went to voicemail. As per our discussion on Monday, the claims for your dad’s oncology and Medication have been created and in process of being assessed so that the refund can be paid out. I had re-escalated it again this morning to the Authorisation manager and am awaiting feedback on when the funds will be paid out. As promised I will provide feedback as and when I get feedback. Kind Regards, Kgomotso Kgosana Customer Care Team Leader e: **********

I called him numerous times after this to follow up on the progress, and he did not return any of my calls. On 1 Dec I insisted to speak to a manager as Kgomotso clearly was not interested in assisting me. I was transferred to Devash Ramdeen. He promised to look into the case an provide me with feedback. By close of business on the 1st he phoned me back to confirm he has assigned one of the agents to review and reprocess all claims submitted on my dad's policy. On the 4th he phoned me to confirm that all claims were reviewed and approved. He is waiting for confirmation on when the payments will be done. On Thursday I left a message for him to call me back, in order to confirm payment date. No response. On Monday the 11th, I left another message for him to call me back, no response. I then asked the call agent to provide me with his email address, and send him an email to ********** requesting feedback on the payment date. My dad was scheduled for his next treatment on 11 and 14 Dec. No reply on my mail. I then send him a follow up mail on the 13th, no reply. I called again on the 13th, and were once again informed that they can not transfer the call as he is busy on a call. The agent assured me he would give him the message to phone me back. Still no call back.

I am really at my end with the terrible service I received. Do I need to escalate my claim to the CEO or Ombudsman before I get any joy. It is no longer good enough to try and help, and then drop the ball time and time again.

I do not expect my dad to be inconvenienced because of mistakes on the side on OnePlan. My dad is making a lot of sacrifices every month to be able to afford this policy to ensure that he and my mom in covered should they need it. Now that they need it, you are providing the most horrible service. I am in a management position at a financial company in the operations space. I know we all make mistakes, but it is how we recover from our mistakes. I make plans every day to try and help clients where possible and to ensure we do not inconvenience our clients. If we make a mistake, I ensure that my team fix it as soon as possible and I know there are always ways to request immediate payments or special payments to clients outside of the normal processes. If we messed up we bend over backwards to fix it ASAP. That is the least I expect from OnePlan.

Can you please assist me with the following: 1. Confirmation that all outstanding claims on my father's policy has been processed (correctly) and will be paid to him within the next 24 hours. 2. A reconciliation of all claims submitted for refund to my father (no need to include claims settled to providers directly) since we activated the dreaded decease cover in May. Indicating the claim submitted, the amount refunded to my father and if not refunded, the reason (for example where benefit threshold has been reached for the year). Please assist with this ASAP. 3. I also need a contact person to who I can submit the claims for December directly to ensure we do not have to experience the same level of horrible service with the next batch of claims submitted. In all honesty, I do not trust the normal process any more.

Kind Regards Marelie Parsons