kK
kallie K
1 reviews | Active since Apr 2011
18 Sept 2024, 13:37
Stratum gap cover bad news stay away
I have been paying stratum gap cover for 3 years, never claimed. I had an angiogram requested by my cardiologist in hospital .The radiographer was not paid fully as it was under PMB. Stratum refuse to pay R167.00.yet I pay over 450 per month. they have a excuse to say my medical aid did not pay it from hospital benefits.
Helpful (0)
Replies (1)0
Replies (1)
Stratum Benefits (Pty) Ltd's replyOfficial
18 Sept 2024, 14:15Good day Mr. Kleynhans
We are sorry to hear that you are dissatisfied with the handling of your claim.
We are sorry to hear that you are dissatisfied with the handling of your claim.
To ensure a thorough review and assessment of claims, we have specific requirements or criteria that needs to be met.
The medical aid rejected one claim line item and as a Gap Cover Provider, we look at shortfalls per line item. If the medical aid does not pay towards a line item, it means there is no shortfall for us to assess as we cannot act as a medical aid. We assess shortfalls per line item / procedure code.
We strongly recommend that you get in contact with Discovery as the rejection reason states they require details from your doctor in order to consider payment.
We are steadfast in our commitment to continuous improvement and the delivery of outstanding customer service to all our valued clients.
The medical aid rejected one claim line item and as a Gap Cover Provider, we look at shortfalls per line item. If the medical aid does not pay towards a line item, it means there is no shortfall for us to assess as we cannot act as a medical aid. We assess shortfalls per line item / procedure code.
We strongly recommend that you get in contact with Discovery as the rejection reason states they require details from your doctor in order to consider payment.
We are steadfast in our commitment to continuous improvement and the delivery of outstanding customer service to all our valued clients.
Best regards,
The Stratum Benefits Team
Stratum Benefits (Pty) Ltd's reply18 Sept 2024, 14:15
Official
Good day Mr. Kleynhans
We are sorry to hear that you are dissatisfied with the handling of your claim.
We are sorry to hear that you are dissatisfied with the handling of your claim.
To ensure a thorough review and assessment of claims, we have specific requirements or criteria that needs to be met.
The medical aid rejected one claim line item and as a Gap Cover Provider, we look at shortfalls per line item. If the medical aid does not pay towards a line item, it means there is no shortfall for us to assess as we cannot act as a medical aid. We assess shortfalls per line item / procedure code.
We strongly recommend that you get in contact with Discovery as the rejection reason states they require details from your doctor in order to consider payment.
We are steadfast in our commitment to continuous improvement and the delivery of outstanding customer service to all our valued clients.
The medical aid rejected one claim line item and as a Gap Cover Provider, we look at shortfalls per line item. If the medical aid does not pay towards a line item, it means there is no shortfall for us to assess as we cannot act as a medical aid. We assess shortfalls per line item / procedure code.
We strongly recommend that you get in contact with Discovery as the rejection reason states they require details from your doctor in order to consider payment.
We are steadfast in our commitment to continuous improvement and the delivery of outstanding customer service to all our valued clients.
Best regards,
The Stratum Benefits Team