This Confusion and disarray in their processes are making my life increasingly difficult

Dear One Plan Insurance,

I am writing to formally express my extreme frustration and disappointment with the way my claims have been handled recently. My family and I have been loyal clients of One Plan Insurance for several years, consistently paying our premiums, yet it seems you are now making every possible excuse to avoid processing my claims. Please note, all correspondence from your representatives has been attached.

On 1 October 2024, I submitted my handwritten cash receipt for reimbur*****t, which included all necessary details: the amount paid, my personal information, the consultation details and the Doctor’s stamp, exactly as I have done since the beginning of my time with you. However, I was informed that you now require a detailed invoice that includes:

• Services rendered • Patient and Doctor's details • Practice number • Amount charged, along with proof of payment • Service date

In response to this, I requested my doctor to prepare a typed, detailed invoice containing all the information you requested. I submitted this, only to be told you would no longer accept my original handwritten cash receipt as proof of payment because, according to your exact words, "due to recent changes and ***** experience with handwritten invoices, we request that you provide a detailed printed invoice or statement which will serve as proof of payment."

After a frustrating 20-minute phone call, where I fought against this arbitrary new requirement, I had no choice but to return to my doctor for a third time to provide a printed invoice as proof of payment, as requested. After two weeks of back-and-forth and unnecessary delays, this invoice was finally accepted and the claim was approved.

However, on 21 October 2024, following another consultation for bronchitis, I submitted my claim in the exact same format that had been approved just one week prior. To my disbelief, this claim was rejected once again with the same vague reasoning from your representative that "a detailed invoice with proof of payment" was required. I submitted the proof of payment as received from my doctor, printed as per your previous demands and now you claim in your exact words that "a proof of payment, i.e., a stamped cash receipt or slip, is required for the claim to be assessed."

This very slip, which you rejected a week earlier, is now somehow the required document.

Your process is not only inconsistent and illogical but also feels purposefully obstructive. It is increasingly clear that One Plan Insurance is more than willing to take my premiums every month but is now actively finding reasons to avoid paying out even the most straightforward of claims. This behavior is dishonest and verges on theft. If this is happening to me, I shudder to think how many others are being denied rightful claims through these bureaucratic tactics.

As a mother of two, with a third child on the way, a wife and a full-time marketing manager, I simply do not have the time to continually run back and forth to my doctor for paperwork that you seem determined not to honor. It’s clear your staff are either poorly trained or your company is intentionally de*****ing clients. One representative tells me one thing, while another tells me something entirely different. This confusion and disarray in your processes are making my life increasingly difficult and it must be addressed immediately.

I demand that you review my claim and approve it without any further delay. If this issue is not resolved satisfactorily and promptly, I will have no choice but to escalate this matter to the Ombudsman, Carte Blanche, EWN News and several other media outlets for investigation. I can only imagine how many others are also being misled by your ever-changing requirements.

I expect a resolution and a response to this matter or I will take further action.