Email chaos, review systems, collate and reply to save your admin?

I have been trying to get an explanation to my question since 4 Jan saying my claim was repudiated as there was no shortfall. I seems odd to try and claim for a nonexistent shortfall, but I guess in this world people try anything. That said I have furnished the detail and asked how my shortfall "wasn't" a shortfall. No response no reply. On the 8th, I received an email saying they were trying to call me. I explained I couldn't be reached on that number since I am currently not in South Africa and gave an alternative incl WhatsApp. Since then I have written 6x. On Wednesday 17th, I let them know that if I didn't get an explanation, I would escalate to social media and failing that the ombudsman. Today is Saturday and still no word. In a sense what stings the most is that in over 5 years of premiums we have never claimed, yet a +/- R2000 claim is rejected with no explanation. A ruling isn't an explanation. On a related note, I have received at least 6 emails asking me to file my claim correctly, well that is what it seems. Odd since it has been processed. I did reply asking if it was a general email or for me to attend to since I wasn't sure if the code supp**** was actually the ICD code they are looking for. I think you have guessed, no response, but the same email over and over.

I would love resolution.

Hi Sean Davis, RE: CLAIMS NO: (CL208416) - Date of Event:2023-06-29 The above claim has been assessed in line with the policy wording terms and using the International Classification of Diseases coding (ICD-10). This is a diagnostic coding standard that was adopted by the South African National Department of Health in 1996. All the documentation received to date has been thoroughly examined, and we unfortunately have to advise that the claim is repudiated. Provider: Centre of Advanced Medicine The claim has been repudiated based on the following: 23. GUARANTEE CLAUSE The stated benefit amount payable is not related to the specific cost of any medical expense shortfall or non-medical expense cover because of hospitalisation. Only a medical scheme product can guarantee payment of full medical expense shortfall costs associated with a health event.