1 reviews | Active since Oct 2023
The hard-to-face fact about Oneplan Insurance
As a person that doesn't like to take risks, I've made extra provision for when I might someday find myself in a situation where I would need extra medical care some day. I took out extra insurance in order to cover extra medical expenses that could quickly run sky high in our country. Sadly, I did not ever dream that despite all my precautions taken not to be in a situation like this, it is exactly where I ended up. When I complained on this forum after I had a serious fall in my own backyard a month ago, Oneplan pulled a publicity stunt and made promises that they did not intend to keep, still coming back rejecting my claims and even now asking me to give back money initially paid to my Onecard for the emergency room expenses at Netcare Pretoria East hospital. These were legitimate expenses for which I supp**** ample proof of invoices and statements. My new claims are not even listed on the claim history, as if they are shadow-banned, as consultants can't locate them, telling me its an "App" problem. Please take my advice and stay away from Oneplan Health Insurance. From an accident cover of R216 000 per incident on my policy, they paid my first dental expense of R2 677, leaving me with a CT scan account of R10 040, emergency room expenses of R5 150 and R4 900 in sonar- and hand therapy costs to date for a fracture in my hand. I am seeing an orthopedic surgeon in the new year to fix what an x-ray did not initially pick up at the emergency room, having lost a significant part of function in my hand. Does Oneplan care? No they don't care at all. Their excuse is that the x-ray did not show any fracture and because I have not been admitted to hospital at that stage, any and all further claims are rejected. They also penalise me for a mistake that the hospital emergency room made, by not acting within the triage (levels of seriousness) - something that I did not have any control over, whatsoever. I have totally lost faith in the insurance industry. Time for me to go back to old-fashioned medical aid. Don't fall for the promises, they will always, always find some lame excuse to deny and reject your claims. This is the sad truth.
Thank you for taking the time to bring this to our attention.
We have attempted to contact you on the listed number; however, it was to no avail.
Kindly note that we grant the authorization for in-hospital claims based on the information that the hospital provides us with which includes the patient's clinical and vital signs, unfortunately, authorization for Admission cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Please note that payment of in-hospital claims can be paid directly to the service provider or a refund can be processed to the client once we receive all the relevant documentation up to the respective cover limits.
Should the hospital confirm the Triage color to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover. When the patient is informed of the Triage color and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
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 our client's 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 been in contact with the service providers and have sent an email to your listed email address with feedback.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
We have attempted to contact you on the listed number; however, it was to no avail.
Kindly note that we grant the authorization for in-hospital claims based on the information that the hospital provides us with which includes the patient's clinical and vital signs, unfortunately, authorization for Admission cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Please note that payment of in-hospital claims can be paid directly to the service provider or a refund can be processed to the client once we receive all the relevant documentation up to the respective cover limits.
Should the hospital confirm the Triage color to be Green, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green Triage is Not covered under the emergency cover. When the patient is informed of the Triage color and benefit that the health insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
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 our client's 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 been in contact with the service providers and have sent an email to your listed email address with feedback.
Kind Regards,
Oneplan