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CANDICE H
1 reviews | Active since Sept 2018
12 Sept 2022, 11:42
DO NOT GET GAP COVER WITH THEM, THEY DO NOT APPLY THE POLICY FAIRLY.
DO NOT GET GAP COVER WITH STRATUM - MERCER MARSH BENEFITS.
I had previous GAP cover with another service provider with years of excellent service. I went with Stratum when my company changed over to them, they are pathetic and not client orientated at al!!!!!
- In 2018 my maternity claims were delayed by about 4 months until I complained to the head of HR at my company and he logged a complaint - I had major abdominal surgery in December 2021, the service provider made an admin error and did not send me the invoice within the 6 months period, rather a few days shy of that, I duly paid the invoice. I provided written proof that I was not the reason for the delay and in accordance with TCF legislation my claim should be covered. The pathetic claims assessors are looking at the policy blindly and refusing to cover my claim. - This is the second claim from the op that Stratum is refusing to pay, I wish I had never moved over- I will be going back to my previous provider
If I could have given them a negative rating I would have
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Replies (6)0
Replies (6)
Stratum Benefits (Pty) Ltd's replyOfficial
12 Sept 2022, 12:07Dear Candice,
Thank you for bringing your concern to our attention regarding the processing of your claims.
We have escalated your complaint to the claims management team for further assistance.
We do apologize for any unintended frustrations.
Best regards,
The Stratum Benefits Team
Thank you for bringing your concern to our attention regarding the processing of your claims.
We have escalated your complaint to the claims management team for further assistance.
We do apologize for any unintended frustrations.
Best regards,
The Stratum Benefits Team
Stratum Benefits (Pty) Ltd's reply12 Sept 2022, 12:07
Official
Dear Candice,
Thank you for bringing your concern to our attention regarding the processing of your claims.
We have escalated your complaint to the claims management team for further assistance.
We do apologize for any unintended frustrations.
Best regards,
The Stratum Benefits Team
Thank you for bringing your concern to our attention regarding the processing of your claims.
We have escalated your complaint to the claims management team for further assistance.
We do apologize for any unintended frustrations.
Best regards,
The Stratum Benefits Team
Stratum Benefits (Pty) Ltd's replyOfficial
12 Sept 2022, 15:42Complaint Update:
Dear Candice,
Our claims manager has contacted the doctor’s rooms to get their version of events , you stated that you didn’t’ get the invoice on time, but the screenshots sent to our claims team, show that the invoice was sent on the 17th of January 2022.
The accounts manager(from the doctors room) is unavailable right now but they’ve asked that we email them so long which we have done.
We will update you as soon as they respond to our email with confirmation of the date they first sent you the correct invoice.
Best regards
The Stratum Benefits Team
Dear Candice,
Our claims manager has contacted the doctor’s rooms to get their version of events , you stated that you didn’t’ get the invoice on time, but the screenshots sent to our claims team, show that the invoice was sent on the 17th of January 2022.
The accounts manager(from the doctors room) is unavailable right now but they’ve asked that we email them so long which we have done.
We will update you as soon as they respond to our email with confirmation of the date they first sent you the correct invoice.
Best regards
The Stratum Benefits Team
Stratum Benefits (Pty) Ltd's reply12 Sept 2022, 15:42
Official
Complaint Update:
Dear Candice,
Our claims manager has contacted the doctor’s rooms to get their version of events , you stated that you didn’t’ get the invoice on time, but the screenshots sent to our claims team, show that the invoice was sent on the 17th of January 2022.
The accounts manager(from the doctors room) is unavailable right now but they’ve asked that we email them so long which we have done.
We will update you as soon as they respond to our email with confirmation of the date they first sent you the correct invoice.
Best regards
The Stratum Benefits Team
Dear Candice,
Our claims manager has contacted the doctor’s rooms to get their version of events , you stated that you didn’t’ get the invoice on time, but the screenshots sent to our claims team, show that the invoice was sent on the 17th of January 2022.
The accounts manager(from the doctors room) is unavailable right now but they’ve asked that we email them so long which we have done.
We will update you as soon as they respond to our email with confirmation of the date they first sent you the correct invoice.
Best regards
The Stratum Benefits Team
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CANDICE H's updateReviewer Update
12 Sept 2022, 19:01Good Day
This response indicates that the claims assessors have not read the emails I have provided on/1 more than one occasion. The invoice sent to on 17/01/2022 was not correct- it did not have the amounts covered by the medical aid. I disputed this and the accounts manager Marelise who reverted to me on 03/2/2022 stating that I was owed a refund - no mention of an invoice. I requested for her to clarify this, no response received until July 2022 when I received a call from Annelise from their offices in respect of the invoice. I asked for an emailed copy and it was then sent to me.
This response indicates that the claims assessors have not read the emails I have provided on/1 more than one occasion. The invoice sent to on 17/01/2022 was not correct- it did not have the amounts covered by the medical aid. I disputed this and the accounts manager Marelise who reverted to me on 03/2/2022 stating that I was owed a refund - no mention of an invoice. I requested for her to clarify this, no response received until July 2022 when I received a call from Annelise from their offices in respect of the invoice. I asked for an emailed copy and it was then sent to me.
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CANDICE H's update12 Sept 2022, 19:01
Reviewer Update
Good Day
This response indicates that the claims assessors have not read the emails I have provided on/1 more than one occasion. The invoice sent to on 17/01/2022 was not correct- it did not have the amounts covered by the medical aid. I disputed this and the accounts manager Marelise who reverted to me on 03/2/2022 stating that I was owed a refund - no mention of an invoice. I requested for her to clarify this, no response received until July 2022 when I received a call from Annelise from their offices in respect of the invoice. I asked for an emailed copy and it was then sent to me.
This response indicates that the claims assessors have not read the emails I have provided on/1 more than one occasion. The invoice sent to on 17/01/2022 was not correct- it did not have the amounts covered by the medical aid. I disputed this and the accounts manager Marelise who reverted to me on 03/2/2022 stating that I was owed a refund - no mention of an invoice. I requested for her to clarify this, no response received until July 2022 when I received a call from Annelise from their offices in respect of the invoice. I asked for an emailed copy and it was then sent to me.
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CANDICE H's updateReviewer Update
13 Oct 2022, 12:26It is now the 13 October 2022 and Stratum has still not finalised my claim. Today after I sent them 2 emails requesting a response I received feedback that it is still not finalised. No follow up and no feedback, no value of their client. I sent through all the written proof I have that the delay in the matter was due to the medical service provider and not myself but only the broker seems to have grasped the written evidence I sent through on numerous occasions and has agreed that my claim should be paid. Stratum does not work in the interest of and in fairness to clients. They are still looking for reasons not to cover me for a legitimate coverable insured event. Please do not ever use this company, there prices are higher than most and they are inefficient, not customer orientated and the claims staff do not understand TCF legislation governing their policy.
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CANDICE H's update13 Oct 2022, 12:26
Reviewer Update
It is now the 13 October 2022 and Stratum has still not finalised my claim. Today after I sent them 2 emails requesting a response I received feedback that it is still not finalised. No follow up and no feedback, no value of their client. I sent through all the written proof I have that the delay in the matter was due to the medical service provider and not myself but only the broker seems to have grasped the written evidence I sent through on numerous occasions and has agreed that my claim should be paid. Stratum does not work in the interest of and in fairness to clients. They are still looking for reasons not to cover me for a legitimate coverable insured event. Please do not ever use this company, there prices are higher than most and they are inefficient, not customer orientated and the claims staff do not understand TCF legislation governing their policy.
Stratum Benefits (Pty) Ltd's replyOfficial
13 Oct 2022, 12:57Dear Candice,
An update on your complaint was sent to you on email on the 16th of September 2022 at 09:10 am which you responded on and included the practice manager.
We don't look for reasons not to pay your claim or any claim for that matter, our claims stats can attest to that, we are sorry you feel that way.
We are unfortunately unable to review this claim with the evidence we've currently been provided with by the Doctor's room.
Best regards
The Stratum Benefits Team
An update on your complaint was sent to you on email on the 16th of September 2022 at 09:10 am which you responded on and included the practice manager.
We don't look for reasons not to pay your claim or any claim for that matter, our claims stats can attest to that, we are sorry you feel that way.
We are unfortunately unable to review this claim with the evidence we've currently been provided with by the Doctor's room.
Best regards
The Stratum Benefits Team
Stratum Benefits (Pty) Ltd's reply13 Oct 2022, 12:57
Official
Dear Candice,
An update on your complaint was sent to you on email on the 16th of September 2022 at 09:10 am which you responded on and included the practice manager.
We don't look for reasons not to pay your claim or any claim for that matter, our claims stats can attest to that, we are sorry you feel that way.
We are unfortunately unable to review this claim with the evidence we've currently been provided with by the Doctor's room.
Best regards
The Stratum Benefits Team
An update on your complaint was sent to you on email on the 16th of September 2022 at 09:10 am which you responded on and included the practice manager.
We don't look for reasons not to pay your claim or any claim for that matter, our claims stats can attest to that, we are sorry you feel that way.
We are unfortunately unable to review this claim with the evidence we've currently been provided with by the Doctor's room.
Best regards
The Stratum Benefits Team
CH
CANDICE H's updateReviewer Update
13 Oct 2022, 13:58What about the written evidence provided by myself which clearly contradicts the alleged evidence provided by the medical providers admin manager, who was clearly negligent in this matter. She has undoubtledly provided you with a version that is incorrect. What about the broker who considered my claim and stated that my claim should be paid? Stratum is basing their decision on the version which suits my claim not being paid, not on the evidence presented.
Stats aside, consumers need to see how customers are treated by this institution, my email from the 16/09/2022 was not rep**** to until I requested feedback on 11/10/2022 and 12/10/2022 and then proper consideration wasnt given in terms of the written evidence presented. In terms on the Treating Customers Fairly Legislation there is non compliance.
Stats aside, consumers need to see how customers are treated by this institution, my email from the 16/09/2022 was not rep**** to until I requested feedback on 11/10/2022 and 12/10/2022 and then proper consideration wasnt given in terms of the written evidence presented. In terms on the Treating Customers Fairly Legislation there is non compliance.
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CANDICE H's update13 Oct 2022, 13:58
Reviewer Update
What about the written evidence provided by myself which clearly contradicts the alleged evidence provided by the medical providers admin manager, who was clearly negligent in this matter. She has undoubtledly provided you with a version that is incorrect. What about the broker who considered my claim and stated that my claim should be paid? Stratum is basing their decision on the version which suits my claim not being paid, not on the evidence presented.
Stats aside, consumers need to see how customers are treated by this institution, my email from the 16/09/2022 was not rep**** to until I requested feedback on 11/10/2022 and 12/10/2022 and then proper consideration wasnt given in terms of the written evidence presented. In terms on the Treating Customers Fairly Legislation there is non compliance.
Stats aside, consumers need to see how customers are treated by this institution, my email from the 16/09/2022 was not rep**** to until I requested feedback on 11/10/2022 and 12/10/2022 and then proper consideration wasnt given in terms of the written evidence presented. In terms on the Treating Customers Fairly Legislation there is non compliance.