We have had a terrible Oneplan Health Insurance Experience

We have had a terrible Oneplan Health Insurance Experience

I am not one to take to social media to complain, but I feel like it is the only way now to get sufficient help from Oneplan Medical Insurance, as it seems they promptly reply to social media complaints but not to countless emails and calls asking for assistance.

We have been with Oneplan since 2018 and have mostly been satisfied with their day-to-day minor services, however when you have to deal with more serious matters, they have been shocking. We have been so disappointed with their service the last 2 years.

During these years, we’ve encountered numerous issues, including delayed payments to service providers. Most importantly, when there is a significant health issue or scare, they go silent, and you're assisted only through automated emails and multiple consultants, forcing you to explain your issue repeatedly. The latest and most pressing issue has been my pregnancy.

It’s been a really tough pregnancy in general. On November 29th, I ended up in the hospital during a work trip in Pongola due to preterm labor, though no delivery took place. (I state that clearly because Oneplan’s compliance division has been very 'clever' in skirting around the fact that this incident could actually fall under the Illness In Hospital benefit).

Thankfully, it did not result in delivery, thanks to a miracle and Dr. Pupuma at Netcare The Bay Hospital in Richards Bay. I was experiencing contractions every minute that lasted for 1.5 minutes each, with pain at about 5 out of 10. Netcare The Bay Hospital was incredible in their service and attentiveness. After my hospitalization, they communicated well with us and ensured that claims were submitted to Oneplan effectively.

Unfortunately, I cannot say the same for Oneplan Health Insurance. It started with an automatic email notifying us that the bills incurred would be covered by our maternity benefit, with a maximum of R55,000 for a NATURAL BIRTH. This amount also covers emergency C-sections but not voluntary ones. When we were made aware of this, our hearts sank, as we realized that our Maternity Benefit would then be drained and we would have to pay cash for the birth of our child, and we do not have R55,000 just lying around.

I scoured through the policy schedule to see why it had to fall under the Maternity Benefit. I then noticed that the incident might fall under the Illness In Hospital benefit, as no actual birth took place, and there could be many reasons for the contractions, such as an infection etc.

We immediately reached out to Oneplan to ask if this could be covered under the Illness In Hospital benefit, as there was no actual "birth." We explained that this was a very time-sensitive issue and needed help resolving it as soon as possible. From the start, I requested to deal with ONE person, as my experience has been that I get passed from one agent to another, having to explain my case over and over again.

Not just one life, but two lives were at risk here as I could go into labour at any stage.

I sent numerous emails and called the customer care line (which was of NO help). I kept receiving generic and automatic responses, while days passed without any real help or guidance. When I finally did get an email from a ‘person,’ it was unhelpful, unclear, and lacked any understanding or compassion. The response simply referred to the fine print and suggested contacting the complaints department if I was not satisfied.

Throughout my emails, I asked, Please can I speak to a person? I need a number; this is a very urgent case. The service and communication were shocking, with days going by without a response. I continued to receive generic answers and unhelpful information, all while repeatedly asking for one person to take responsibility, as the case was very time-sensitive with a baby on the way. Not a single call was made to us, and not a single dedicated person dealt with us. (The agents also rarely put their names at the bottom of the emails.)

We escalated the matter to the Complaints Department immediately. We sent numerous emails, received automatic responses, and once again, days passed without a real response. Emails went back and forth, where we CC'd any and every email address we could find , hoping someone would just help us and resolve this. We needed answers, clarification, and updates on our case. Days passed without any response, and TO THIS DAY, not a single person has called us, despite our repeated pleas for someone to simply pick up the phone.

Everything was left in limbo. Netcare had not been paid, and we had no idea what was happening. We then came up with a plan that we would commit to paying the Netcare Bills ourselves. I reached out to Netcare to see if we could set up a payment plan to cover the hospitalization, and they were very helpful, going above and beyond to assist. But once again, Oneplan was dragging their feet, not responding, not READING and following the email thread properly. They said one thing to us and another to the hospital.

As it stands, I could go into labor at any stage, and we have no idea what is covered or not because we cannot get hold of anyone at Oneplan to clarify what is happening, their emails are also filled with jargon.

And no, the Claims Statement on the OnePlan app is not up-to-date, as there are claims marked as pending from last year that I know have already been paid.

The bottom line is:

- If you experience a crises Oneplan will not be there for you.

- If your pregnancy is not going to be simple and smooth. There is simply not enough maternity cover for any complications.

- Always check where they will be withdrawing the funds from.

- You will not be dealing with a single person, and no one will call you.

- You will wait weeks and weeks to try and resolve issues.

What was meant to be a really special time over December as we wait for our baby to arrive, has turned out to be exceptionally stressful. We have been left in the dark with very little information or guidance. We’ve had to just hope and pray that this baby stays in my belly until we get some answers.