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bntloedibe B
1 reviews | Active since Jul 2017
13 Dec 2022, 13:43
UNPAID CLAIMS FOR *** - ***
Poor and Bad customer services from the beginning of the insurance, On 2021.06.01 we took an insurance for my mother, everything was fine until March 2022 when the doctor didn't receive any claims when he was claiming, secondly we were not even explained or told that before she go for consultation she needs to call first to get fuds into the card only when we call and query is when they explain that to us, now we sitting with outstanding balance which is needed by the doctor, but we have been paying the insurance every month , so who must be responsible for that outstanding amount, I need my refund for any money that was not used in that card failure to do that am going to take further steps, On the 10 November email was send to claims after the doctor complained that there is no paid claim on his account for the below mentioned policy number , 13 December 2022 I re-send the email again and the respond was anything that is 4 months older they don't paid and no one explained anything to us, remember this policy we took it for my mother who is older enough not to understand anything, so I decided to terminate or cancel the policy as I feel that am paying something that doesn't benefit me at all.
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Replies (4)
Oneplan Insurance's replyOfficial
13 Dec 2022, 15:05Good day Lerato,
Thank you for taking the time to bring this to our attention.
Thank you for taking the time to bring this to our attention.
We sincerely apologize that your experience with Oneplan has not been a pleasant one as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
We have attempted to contact you and the policy holder on the listed numbers; however, it was to no avail.
Kindly note that records on our system reflect that funds for Scripted medication and a Doctor’s Visit were loaded on the 02nd of March 2022, however due to the funds not being utilized in a timely manner the system reversed the funds. Please note for day-to-day claims, funds are loaded within 60 seconds onto the Onecard, the system will pull the funds back if the funds are not utilized within 24 - 48 hours. Clients are still able to load new funds should the funds be reversed due to it not being utilized. This is just a security measure put in place since clients have access to load claim funds on the Onecard at any time.
Please be informed that on the 09th of March 2022 we received a statement from the Doctor with no detailed billing. Upon receiving this statement, we did reply to the Doctor's email requesting for an invoice with total costs for the consultation as well as the medication in order for the claim to be processed accordingly. Unfortunately to date we have not received this information from the Doctor.
We have attempted to contact you and the policy holder on the listed numbers; however, it was to no avail.
Kindly note that records on our system reflect that funds for Scripted medication and a Doctor’s Visit were loaded on the 02nd of March 2022, however due to the funds not being utilized in a timely manner the system reversed the funds. Please note for day-to-day claims, funds are loaded within 60 seconds onto the Onecard, the system will pull the funds back if the funds are not utilized within 24 - 48 hours. Clients are still able to load new funds should the funds be reversed due to it not being utilized. This is just a security measure put in place since clients have access to load claim funds on the Onecard at any time.
Please be informed that on the 09th of March 2022 we received a statement from the Doctor with no detailed billing. Upon receiving this statement, we did reply to the Doctor's email requesting for an invoice with total costs for the consultation as well as the medication in order for the claim to be processed accordingly. Unfortunately to date we have not received this information from the Doctor.
According to our policy schedule under General Conditions (point 6.21) it states that claims submitted after four (4) months from the Insured Event will not be accepted. It is the responsibility of the client to ensure that the claim invoices have been received by us. Clients are informed to claim as soon as they can.
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 your mom’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.
Kindly provide us with a suitable time or an alternate contact number as we would like to further discuss the above matter
Once again we apologize for any inconvenience caused and we hope to restore the experience.
Kind Regards,
Oneplan
Oneplan Insurance's reply13 Dec 2022, 15:05
Official
Good day Lerato,
Thank you for taking the time to bring this to our attention.
Thank you for taking the time to bring this to our attention.
We sincerely apologize that your experience with Oneplan has not been a pleasant one as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
We have attempted to contact you and the policy holder on the listed numbers; however, it was to no avail.
Kindly note that records on our system reflect that funds for Scripted medication and a Doctor’s Visit were loaded on the 02nd of March 2022, however due to the funds not being utilized in a timely manner the system reversed the funds. Please note for day-to-day claims, funds are loaded within 60 seconds onto the Onecard, the system will pull the funds back if the funds are not utilized within 24 - 48 hours. Clients are still able to load new funds should the funds be reversed due to it not being utilized. This is just a security measure put in place since clients have access to load claim funds on the Onecard at any time.
Please be informed that on the 09th of March 2022 we received a statement from the Doctor with no detailed billing. Upon receiving this statement, we did reply to the Doctor's email requesting for an invoice with total costs for the consultation as well as the medication in order for the claim to be processed accordingly. Unfortunately to date we have not received this information from the Doctor.
We have attempted to contact you and the policy holder on the listed numbers; however, it was to no avail.
Kindly note that records on our system reflect that funds for Scripted medication and a Doctor’s Visit were loaded on the 02nd of March 2022, however due to the funds not being utilized in a timely manner the system reversed the funds. Please note for day-to-day claims, funds are loaded within 60 seconds onto the Onecard, the system will pull the funds back if the funds are not utilized within 24 - 48 hours. Clients are still able to load new funds should the funds be reversed due to it not being utilized. This is just a security measure put in place since clients have access to load claim funds on the Onecard at any time.
Please be informed that on the 09th of March 2022 we received a statement from the Doctor with no detailed billing. Upon receiving this statement, we did reply to the Doctor's email requesting for an invoice with total costs for the consultation as well as the medication in order for the claim to be processed accordingly. Unfortunately to date we have not received this information from the Doctor.
According to our policy schedule under General Conditions (point 6.21) it states that claims submitted after four (4) months from the Insured Event will not be accepted. It is the responsibility of the client to ensure that the claim invoices have been received by us. Clients are informed to claim as soon as they can.
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 your mom’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.
Kindly provide us with a suitable time or an alternate contact number as we would like to further discuss the above matter
Once again we apologize for any inconvenience caused and we hope to restore the experience.
Kind Regards,
Oneplan
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bntloedibe B's updateReviewer Update
13 Dec 2022, 15:47So call me during the day from 08h00 to 17h00 , am busy now please call me tomorrow morning and what is the way forward about this matter, or you load money in the card so that we can be able to pay that doctor's outstanding balance of R4000 for the whole year of 2022 ,
Hope to hear from you soon
Hope to hear from you soon
bB
bntloedibe B's update13 Dec 2022, 15:47
Reviewer Update
So call me during the day from 08h00 to 17h00 , am busy now please call me tomorrow morning and what is the way forward about this matter, or you load money in the card so that we can be able to pay that doctor's outstanding balance of R4000 for the whole year of 2022 ,
Hope to hear from you soon
Hope to hear from you soon
Oneplan Insurance's replyOfficial
13 Dec 2022, 16:41Good day Lerato,
Thank you for reaching out to us.
Kindly note that the cover limit for each benefit is listed in the policy documents that was sent to the email address recorded on the system as there are cover limits on all our cover types,
We will be in contact with you tomorrow morning to further discuss the matter at hand.
Kind Regards,
Oneplan
Thank you for reaching out to us.
Kindly note that the cover limit for each benefit is listed in the policy documents that was sent to the email address recorded on the system as there are cover limits on all our cover types,
We will be in contact with you tomorrow morning to further discuss the matter at hand.
Kind Regards,
Oneplan
Oneplan Insurance's reply13 Dec 2022, 16:41
Official
Good day Lerato,
Thank you for reaching out to us.
Kindly note that the cover limit for each benefit is listed in the policy documents that was sent to the email address recorded on the system as there are cover limits on all our cover types,
We will be in contact with you tomorrow morning to further discuss the matter at hand.
Kind Regards,
Oneplan
Thank you for reaching out to us.
Kindly note that the cover limit for each benefit is listed in the policy documents that was sent to the email address recorded on the system as there are cover limits on all our cover types,
We will be in contact with you tomorrow morning to further discuss the matter at hand.
Kind Regards,
Oneplan
Oneplan Insurance's replyOfficial
14 Dec 2022, 09:06Good day Lerato,
Kindly note that we have attempted to contact the listed numbers as well as the policy holder, however both numbers are switched off.
Please provide us with a an alternative number or suitable time to further discuss the matter at hand.
Kind Regards,
Oneplan
Kindly note that we have attempted to contact the listed numbers as well as the policy holder, however both numbers are switched off.
Please provide us with a an alternative number or suitable time to further discuss the matter at hand.
Kind Regards,
Oneplan
Oneplan Insurance's reply14 Dec 2022, 09:06
Official
Good day Lerato,
Kindly note that we have attempted to contact the listed numbers as well as the policy holder, however both numbers are switched off.
Please provide us with a an alternative number or suitable time to further discuss the matter at hand.
Kind Regards,
Oneplan
Kindly note that we have attempted to contact the listed numbers as well as the policy holder, however both numbers are switched off.
Please provide us with a an alternative number or suitable time to further discuss the matter at hand.
Kind Regards,
Oneplan