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Arina C

1 reviews | Active since Feb 2012

19 Sept 2023, 11:02

USELESS medical "insurance"

On 18 September 2023 the dependant Marika saw Dr Roberts again and she suggest that the patient must be admitted ASAP which I have sent through the treatment plan as well as the biopsy results that was done out of my own pocket in January 2023 requesting for authorization to admit the patient at Mediclinic Potchefstroom.

Later the afternoon I have phoned your authorization department which the lady explained that you need a treatment plan (which is there) from the admitting Dr and that you (Oneplan) don't pay for diagnostic testing... In the first place on the previous email you never said anything about diagnostic testing being an exclusion, only that scopes can only be done after my inception date which was 01/07/2023. Now my question is how can the Dr give a specific diagnosis when the patient must do some medical test first before confirming the final diagnosis? No person in the whole world is transparent. NO DR can give a diagnosis before treating the patient FIRST. I will actually know because I'm working with hand in hand with a specialist physician everyday.

I would like to be refunded my 14 months that I paid every month but didn't get any JOY at all because there is constantly a change of story. I will rather move to a company that understand medical problems. I will not leave this matter here I'm going to take this further.

Please cancel my membership, you are honestly useless.

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Replies (1)
Oneplan Insurance
Oneplan Insurance's reply19 Sept 2023, 13:54
Official
Good day Arina,
 
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.
 
We sincerely apologize for any inconvenience caused and the circumstances under which your Hellopeter posting has reached as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.  

Kindly note that diagnostic tests are a general exclusion under the in-hospital benefit. 
 
In order for an Admission authorization to be granted we require the treatment plan from the hospital which will confirm an active treatment to treat the confirmed condition and not observation or diagnosis. Each approved admission/event must have either confirmed diagnostic reports or alternatively a treatment plan with symptoms. For us to assist a funding decision can only be given based on the information provided by the hospital. 
 
Kindly note that the motivation letter we received dated the 15th of September 2023 states that the doctor wishes to proceed with the diagnostic test as the letter indicates 3 types of conditions and needs these diagnostic tests to be confirmed. 
 
Please take note that the General Exclusions on your policy documents confirm that we will not be liable for expenses, hospitalization, injury, sickness or disease directly or indirectly caused by or related to admission to a medical facility/hospital for investigative purposes and/or pain control. 
 
As per our policy terms and conditions, any cancellation requests must be sent in writing to ***. There is a thirty-one (31) day (one calendar month) notice period for all cancellation requests. 
 
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. 
           
Once again, we apologize for any inconvenience caused.
                    
Kind Regards,
Oneplan