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Lu-Ann

1 reviews | Active since Sept 2023

23 Apr 2025, 14:24

Very disappointed, pre authorisation not approved!!

If I could I would give a zero rating. I called the for pre authorisation for admission by my doctor. Initially I gave them what the doctor wrote to admission reception, i did not at that point have the codes, the reception also did not have the code and had to call the doctor. When i called again for pre authorisation after getting the feedback from the doctor still it was not good enough and they told the receptionest I must go to emergency, they've approved my claim for emergency. Mind you I've been at emergency with this issue and was not assisted and on top of that had to pay thousands out of my pocket. I called back again to undestand why the pre authorisation can not be approved and was told the consultant that i spoke to before wrote a note that I cannot be treated for pain relief. So now my question is what type of medical treatment am I supposed to get, or do I pay this health insurance so that I must do my own treatment at home? This is really disappointing, where am I suppose to get medical treatment if I can't use Oneplan. I spoke to 3 consultants. The first one I don't remember their name, the other two is Kefiloe Mannathoko and Nthabiseng Vega

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Replies (3)
Oneplan Insurance
Oneplan Insurance's reply23 Apr 2025, 14:45
Official
Hi Lu-Ann,

Thank you for taking the time to bring this to our attention.  We apologize for any inconvenience that has been caused and for the circumstances under which your Hellopeter posting has reached us. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations as we do value you as our client. 
 
We have acknowledged your complaint, and would like to have a look into it and address your concerns. The matter has been escalated to the relevant department and we will provide you with feedback once received.
            
Once again, we apologize for any inconvenience caused and we hope to restore the experience. 
                     
Kind regards,
Oneplan. 
Oneplan Insurance
Oneplan Insurance's reply23 Apr 2025, 15:46
Official
Hi Lu-Ann,

We acknowledge your frustration and concerns and would like to clarify that a referral from one specialist to another does not automatically qualify as a request for hospital admission. For an admission to be considered, it must be formally requested by the treating specialist, accompanied by a relevant treatment plan. In your case, no admission request was submitted by the treating doctor. However, we fully understand your concern regarding the urgency of the symptoms experienced. In light of this, and as a gesture of leniency to ensure immediate access to care, a casualty authorisation was issued. This was done to facilitate urgent treatment and to allow the treating specialist to assess the situation and, if necessary, submit a formal admission request. We hope this explanation clarifies the process and assures you that your wellbeing remains our top priority. 

Should you require any further assistance or have additional concerns, please don’t hesitate to reach out. 

Kind regards
Oneplan.
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Lu-Ann's update23 Apr 2025, 16:12
Reviewer Update
I still don't understand this is not a specialist to specialist refferal. It is a specialist admitting me. because while I was at the hospital i was told that the consultant needs to speak to the hospital, which they did. When they talk to the hospital the story changes that I must go to casualty. Why now I'm getting access to casualty but when I requested it before I couldn't get it. So now that my doctor wants me to be admitted now I also can't, now you want to pay for casualty what kind of nonsense is this. You are quick to pull funds from my account monthly but when I need medical assistance I must go up and down like a stupid.