They do not practice what they preach!!!

 Good morning Dionne  Thank you for bringing your dissatisfaction to our attention.  We pride ourselves on covering shortfalls when a claim meets the qualifying criteria, but it’s safe to say that not all claims meet the criteria that allows us to cover the gap.  We’d like to quickly explain a typical scenario…  A specialist’s account generally consists of a couple of coded lines. These coded lines indicate what type of consultation you had, what procedure was done, etc. For each coded line, a rand amount is charged by the specialist which your medical aid covers up to the medical aid rate. If the specialist charged more than the medical aid rate, a shortfall exists and this is where we come in.  We assess each of those codes lines to see what was charged by the specialist and what your medical aid paid, but if your medical aid didn’t pay anything towards one or more of those coded lines, then Gap Cover can’t either. If the medical aid doesn’t pay a portion of a coded line, then there isn’t a shortfall because the full cost associated with that coded line would still be owing. This is unfortunately the reason why we weren’t able to pay the full shortfall because for whatever reason, your medical aid rejected the amount charged by your specialist which left no gap for us to cover.  We’re terribly sorry that we couldn’t come through for you. If your medical aid happens to make part payment on those coded lines, you’re welcome to submit a new claim and we’ll gladly have a look.  Kind regards, The Stratum Benefits Team