CS
Coen S
1 reviews | Active since Jun 2025
17 Aug 2026, 20:57
VET MOTIVATION FOR IN-HOSPITAL TREATMENT DECLINED BY ONEPLAN AUTHORISATION TEAM, WHILST ON ACTIVE PET HOSPITAL PLAN
After a really good experience a couple of years ago, my wife and I are extremely dissapointed how our dog Tessa's pre-authorisation request for in-hospital treatment was handled.
First of all, there were technical issues contacting OnePlan, not for the first time, but last time it was handled beautifully by Kim from the pre-auth team, who phoned me back right away - this time, we were told that we would be phoned back multiple times. We had been waiting for over an hour for a call back in the vet waiting room when we were notified, via email, that our dog's in-hospital treatment plan/estimate was declined.
At this point our dog could not walk and was visibly in a significant amount of pain.
Our vet sent an additional motivation letter right away, but discerningly, this was declined as well.
Note that we are on a hospital plan for our three pets (2 cats and a dog), but OnePlan claims a dogbite with heavy infection is a causality and claims the treatment should be different than in-hospital (again, as recommended by TAH Rosmead).
I've gone back and forth with them to pay for the outpatient treatment we could only afford and caused another cure of antibiotics to be required (more bites were found on upper leg which would have been found with in-hospital treatment) - because my pet should have been covered in the first place but they aren't budging.
The incident happened on the 5th of August. Today is the 17th.
We are now entering a formal complaints procedure.
I also requested phone call recordings early last week but have not received these yet.
I hope that this may help someone else make an informed decision about the ligitimacy of OnePlan's pet insurance.
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Replies (2)
Oneplan Insurance's replyOfficial
18 Aug 2026, 07:28Dear Coen,
Thank you for taking the time to share your concerns with us.
We understand how worrying it can be when your fur baby requires veterinary treatment, and we appreciate that the outcome of this claim may be disappointing. Our intention is always to assess claims fairly and in accordance with the policy benefits and terms available to our clients.
Having reviewed the claim, we would like to provide some clarification regarding the outcome.
Based on the information and supporting documentation received, your fur baby was treated on an outpatient basis, which included a consultation and medication dispensed for home treatment. However, there was no overnight admission and no corrective procedure was performed.
In order for a claim to be considered under the Hospital Admission Benefit, the treatment rendered must meet the requirements of the Admission Matrix as outlined in the policy terms and conditions. The invoice submitted does not reflect treatment or services that satisfy the admission criteria required for assessment under this benefit. Consequently, the claim cannot be considered under the In-Hospital Benefit.
We would also like to clarify that admissions and/or hospitalisations solely for diagnostic procedures, monitoring, or observation are specifically excluded from cover under the Hospital Admission Benefit. Where the treatment rendered does not meet the Admission Matrix requirements, the claim may only be considered under the applicable Casualty Benefit, subject to the available cover limits and plan eligibility.
Please note that the repudiation of this claim is based solely on the terms and conditions of the policy and the information contained in the veterinary records and invoice submitted for assessment. The decision is not intended to question the clinical necessity of the treatment provided, nor does it suggest that your fur baby did not require veterinary care. Rather, it reflects the scope of cover available under the selected policy and the benefit criteria that must be met for a claim to qualify.
The formal repudiation letter regarding this has been sent to your listed email address.
The formal repudiation letter regarding this has been sent to your listed email address.
We understand that this may not be the outcome you were hoping for, and we sincerely regret any frustration or disappointment this may have caused. We value your trust in Oneplan and remain committed to providing clear and transparent information regarding your cover and benefits.
We trust that the above clarifies the matter and, most importantly, we wish your fur baby a full and speedy recovery.
Kind regards,
Oneplan.
Oneplan.
Oneplan Insurance's reply18 Aug 2026, 07:28
Official
Dear Coen,
Thank you for taking the time to share your concerns with us.
We understand how worrying it can be when your fur baby requires veterinary treatment, and we appreciate that the outcome of this claim may be disappointing. Our intention is always to assess claims fairly and in accordance with the policy benefits and terms available to our clients.
Having reviewed the claim, we would like to provide some clarification regarding the outcome.
Based on the information and supporting documentation received, your fur baby was treated on an outpatient basis, which included a consultation and medication dispensed for home treatment. However, there was no overnight admission and no corrective procedure was performed.
In order for a claim to be considered under the Hospital Admission Benefit, the treatment rendered must meet the requirements of the Admission Matrix as outlined in the policy terms and conditions. The invoice submitted does not reflect treatment or services that satisfy the admission criteria required for assessment under this benefit. Consequently, the claim cannot be considered under the In-Hospital Benefit.
We would also like to clarify that admissions and/or hospitalisations solely for diagnostic procedures, monitoring, or observation are specifically excluded from cover under the Hospital Admission Benefit. Where the treatment rendered does not meet the Admission Matrix requirements, the claim may only be considered under the applicable Casualty Benefit, subject to the available cover limits and plan eligibility.
Please note that the repudiation of this claim is based solely on the terms and conditions of the policy and the information contained in the veterinary records and invoice submitted for assessment. The decision is not intended to question the clinical necessity of the treatment provided, nor does it suggest that your fur baby did not require veterinary care. Rather, it reflects the scope of cover available under the selected policy and the benefit criteria that must be met for a claim to qualify.
The formal repudiation letter regarding this has been sent to your listed email address.
The formal repudiation letter regarding this has been sent to your listed email address.
We understand that this may not be the outcome you were hoping for, and we sincerely regret any frustration or disappointment this may have caused. We value your trust in Oneplan and remain committed to providing clear and transparent information regarding your cover and benefits.
We trust that the above clarifies the matter and, most importantly, we wish your fur baby a full and speedy recovery.
Kind regards,
Oneplan.
Oneplan.
CS
Coen S's updateReviewer Update
18 Aug 2026, 07:55Oneplan, you are completely missing the point.
In your reply, you simply repeated that my policy does not cover outpatient care, completely ignoring the core issue: these outpatient expenses only exist because you wrongfully denied and delayed her fully covered in-hospital treatment in the first place.
On August 5th, my dog Tessa suffered a severe bite wound requiring urgent in-hospital admission and radiology, as explicitly documented by our vet.
Despite full in-hospital coverage under my policy matrix, you repeatedly declined the pre-authorization, subjected us to technical glitches and unkept call-back promises, and ignored my POPIA requests for call records.
Because you blocked her in-hospital care, Tessa was forced to receive sub-optimal outpatient care instead. Missing the initial radiology meant an underlying second bite mark went unnoticed, directly causing avoidable complications and further vet visits.
It is completely unacceptable to refuse reimbur*****t for outpatient costs when those very costs were forced upon us by your wrongful rejection of a valid in-hospital claim.
Furthermore, legitimate claims submitted under my PetMed Booster benefit remain unpaid. I demand immediate reimbur*****t for these forced costs and my overdue medication claims.
In your reply, you simply repeated that my policy does not cover outpatient care, completely ignoring the core issue: these outpatient expenses only exist because you wrongfully denied and delayed her fully covered in-hospital treatment in the first place.
On August 5th, my dog Tessa suffered a severe bite wound requiring urgent in-hospital admission and radiology, as explicitly documented by our vet.
Despite full in-hospital coverage under my policy matrix, you repeatedly declined the pre-authorization, subjected us to technical glitches and unkept call-back promises, and ignored my POPIA requests for call records.
Because you blocked her in-hospital care, Tessa was forced to receive sub-optimal outpatient care instead. Missing the initial radiology meant an underlying second bite mark went unnoticed, directly causing avoidable complications and further vet visits.
It is completely unacceptable to refuse reimbur*****t for outpatient costs when those very costs were forced upon us by your wrongful rejection of a valid in-hospital claim.
Furthermore, legitimate claims submitted under my PetMed Booster benefit remain unpaid. I demand immediate reimbur*****t for these forced costs and my overdue medication claims.
CS
Coen S's update18 Aug 2026, 07:55
Reviewer Update
Oneplan, you are completely missing the point.
In your reply, you simply repeated that my policy does not cover outpatient care, completely ignoring the core issue: these outpatient expenses only exist because you wrongfully denied and delayed her fully covered in-hospital treatment in the first place.
On August 5th, my dog Tessa suffered a severe bite wound requiring urgent in-hospital admission and radiology, as explicitly documented by our vet.
Despite full in-hospital coverage under my policy matrix, you repeatedly declined the pre-authorization, subjected us to technical glitches and unkept call-back promises, and ignored my POPIA requests for call records.
Because you blocked her in-hospital care, Tessa was forced to receive sub-optimal outpatient care instead. Missing the initial radiology meant an underlying second bite mark went unnoticed, directly causing avoidable complications and further vet visits.
It is completely unacceptable to refuse reimbur*****t for outpatient costs when those very costs were forced upon us by your wrongful rejection of a valid in-hospital claim.
Furthermore, legitimate claims submitted under my PetMed Booster benefit remain unpaid. I demand immediate reimbur*****t for these forced costs and my overdue medication claims.
In your reply, you simply repeated that my policy does not cover outpatient care, completely ignoring the core issue: these outpatient expenses only exist because you wrongfully denied and delayed her fully covered in-hospital treatment in the first place.
On August 5th, my dog Tessa suffered a severe bite wound requiring urgent in-hospital admission and radiology, as explicitly documented by our vet.
Despite full in-hospital coverage under my policy matrix, you repeatedly declined the pre-authorization, subjected us to technical glitches and unkept call-back promises, and ignored my POPIA requests for call records.
Because you blocked her in-hospital care, Tessa was forced to receive sub-optimal outpatient care instead. Missing the initial radiology meant an underlying second bite mark went unnoticed, directly causing avoidable complications and further vet visits.
It is completely unacceptable to refuse reimbur*****t for outpatient costs when those very costs were forced upon us by your wrongful rejection of a valid in-hospital claim.
Furthermore, legitimate claims submitted under my PetMed Booster benefit remain unpaid. I demand immediate reimbur*****t for these forced costs and my overdue medication claims.