AF
Anell F

1 reviews | Active since Mar 2014

18 Mar 2022, 12:25

If you want your claim declined, and complaint ignored please use Stratum for GAP cover

While I have already escalated the matter to both FAIS as well as OSTI, I would like to warn other GAP cover holders. Stratum has a way in which their benefits and then their myriad of exclusions entirely contradict each other. There is always another reason why they don't pay out. Then you follow their complaints resolution process.... and wonder by wonder, they do not even respond. Now R 8000 is probably not such a big deal, but in two years I have only submitted one claim, and it was declined within less than two minutes, you actually get an sms when they start working on your claim, to get an sms a minute later, saying declined. Despite all the evidence etc to the contrary having been sent to them, they just said, well follow the complaints resolution process. (Don't even bother with this one) Take care, I can only assume the raving reviews and 5stars come from employees of family of employees, because as per my experience and other people that held policies with Stratum, this is definitely not the case for real customers. However let us see whether the Ombudsman and further escalation can assist in getting my claim settled.

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Replies (1)
Stratum Benefits (Pty) Ltd
Stratum Benefits (Pty) Ltd's reply22 Mar 2022, 12:14
Official
Hi Anell

We appreciate your message and apologise for the frustration you’re experiencing.
 
As per the feedback you’ve received from our Claims Department, we cover shortfalls when your medical aid pays a portion of the cost from a hospital benefit. If they don’t, there won’t be any shortfall for us to cover and because we can’t act as a medical aid we’re not able to cover the full amount.
 
We understand how disappointing this must be for you, but your claim doesn’t allow us to make the payment you’d like us to make because your medical aid didn’t part pay some or all of the coded lines as it appears on your healthcare provider’s account. If they did, the outcome would’ve been very different as there then would’ve been legitimate shortfalls that we would look at covering.
 
We can assure you that all the compliments we receive are from valued clients. We are real people who sometimes get things very right but sometimes very wrong, and therefore we gratefully accept the compliments but also accept the complaints to learn from.
 
We apologise once again for any unhappiness caused and want you to know that if there was any other way we could’ve assessed your claim to ensure payment, we would’ve done so.
 
Best regards, 
The Stratum Benefits Team