1 reviews | Active since Feb 2020
Poor service
Im so upset with this medical insurance Elixi Health. I joined in February 2020 and have not claimed since November 2020. I went on the app and chose a Dr within the network. He facilitated my Covid test in his rooms and I got my results in 2 days which was negative. I didnt hear about any accounts or overdue amounts so i assumed all was covered by the medical aid. In December I went for another Covid test via Lancet and presented my medical aid card, Lancet said this was accepted. I tested positive and then got an sms from Lancet last month that the medical aid hasnt paid and I'm liable for the bill. I just assumed that they only cover one covid test per year. I get another sms ytoday from the Dr i went to in November, his bill hasnt been paid either for the Covid test. I called Elixi and they refuse to my bill as there was no authorisation given for me to have a test. Why would a Dr in your network that facilitates the test hislef need authorisation? I pay this every month and I'm on their highest package and the 2 times I needed to claim it was rejected. Im extremely upset. Elixi further tells me today that if you test positive for Covid then they pay for the test. I was positive in December and they still refuse to pay. "Authorisation is needed prior". Just ridiculous service.
Thank you for reaching out to us.
We are sad to hear of your recent experience.
Please note that Elixi Health is a medical insurance and not a medical aid.
Being a medical insurance, our benefits are stated with specific insured amounts. All members receive policy wording that advises them of their benefits as well as the terms and conditions of their policy.
We further note that Covid-19 Screening was not part of our product offering in 2020 and therefore any screening received for same in 2020 will not be covered; we are however please to confirm that a Covid-19 Screening benefit has been included to all of our plans for 2021. This has also been communicated in your 2021 Renewals pack. We would like to refer you to the below excerpt of your 2021 policy wording which confirms that Pre-authorisation is required for the benefit:
k. Covid-19 Screening:
The benefit is payable if you test positive for COVID-19. Pre-authorisation and referral by a network GP is required
3974: Polymerase chain reaction (PCR)
CO19: PCR SARS-COV-2
3979: SARS-COV-2-PCR
4434: Bacteriological DNA identification (PCR)
Our customer support team will be in contact with you shortly to discuss the matter further with you and provide you with more clarity on benefit utilization.
Regards
TalksureSA team
Thank you for reaching out to us.
We are sad to hear of your recent experience.
Please note that Elixi Health is a medical insurance and not a medical aid.
Being a medical insurance, our benefits are stated with specific insured amounts. All members receive policy wording that advises them of their benefits as well as the terms and conditions of their policy.
We further note that Covid-19 Screening was not part of our product offering in 2020 and therefore any screening received for same in 2020 will not be covered; we are however please to confirm that a Covid-19 Screening benefit has been included to all of our plans for 2021. This has also been communicated in your 2021 Renewals pack. We would like to refer you to the below excerpt of your 2021 policy wording which confirms that Pre-authorisation is required for the benefit:
k. Covid-19 Screening:
The benefit is payable if you test positive for COVID-19. Pre-authorisation and referral by a network GP is required
3974: Polymerase chain reaction (PCR)
CO19: PCR SARS-COV-2
3979: SARS-COV-2-PCR
4434: Bacteriological DNA identification (PCR)
Our customer support team will be in contact with you shortly to discuss the matter further with you and provide you with more clarity on benefit utilization.
Regards
TalksureSA team