1 reviews | Active since Jun 2019
Useless service
I have been a client for over 5 years. This is the second time in all these years that I have claimed. First time I was messed around as well. First time was not successful either.
Now... I claim for the anethatist from my csection. His bill was for R6932. Genesis, my medical aid paid R4187 and I paid the balance of R2744. Which is the amount I am claiming for from my gap cover.
I filled in the claim form and sent it in to claims, with the full medical aid statement as well as the invoices from the doctor himself.
All I kept getting from talksure/ambledowns is that I need to send in the full medical aid statement. Which I attach again... This goes back and fourth 6 times.
Then a lady calls to say the amount is for R300 as that is what the amount is stated on the medical aid statement. I tell her no, look at the line above, the amounts are all stated on the line above... She keeps quite for a few mins and then says she will find out and let me know.
Today I get a lousy payment of R300.
Now please tell me, is it fair I keep paying for a gap cover that does not cover their claims. Does this make sense to keep paying for a service that is useless to me?
Totally useless service. People involved in "assisting" me are Catherine Ganesh and Yashini Govender.
Thank you for reaching out to us.
Your query has been forwarded to one of our senior advises for urgent attention on the matter. They will be in contact with you shortly to discuss the matter further.
Regards
Talksure team
Thank you for reaching out to us.
Your query has been forwarded to one of our senior advises for urgent attention on the matter. They will be in contact with you shortly to discuss the matter further.
Regards
Talksure team
Thank you for allowing the opportunity to respond on the matter.
As per our discussions, the claim was not paid in full as the line item in question was rejected by your Medical Scheme and therefore not claimable through your Gap Cover.
We have been liaising with your appointed broker and whom has advised us that you guys are in receipt of a revised Medical Scheme statement indicative of your Medical Scheme contributing to the line item.
We have immoderately been keeping in contact with your broker requesting for the revised Medical Scheme statement in order for the claim to be reviewed and we note that this has regrettably not being provided.
Based on the current claim documents provided, we are of the view that the claim assessment is correct and just and therefore the decision remains upheld.
Upon receipt of the revised Medical Scheme statement, the claim will be revisited; kindly refer to the claim dispute process as set out on your Gap cover statement to ensure that that you are aware of the relevant process.
We trust that you find the above to be in order.
Regards
Talksure team
Thank you for allowing the opportunity to respond on the matter.
As per our discussions, the claim was not paid in full as the line item in question was rejected by your Medical Scheme and therefore not claimable through your Gap Cover.
We have been liaising with your appointed broker and whom has advised us that you guys are in receipt of a revised Medical Scheme statement indicative of your Medical Scheme contributing to the line item.
We have immoderately been keeping in contact with your broker requesting for the revised Medical Scheme statement in order for the claim to be reviewed and we note that this has regrettably not being provided.
Based on the current claim documents provided, we are of the view that the claim assessment is correct and just and therefore the decision remains upheld.
Upon receipt of the revised Medical Scheme statement, the claim will be revisited; kindly refer to the claim dispute process as set out on your Gap cover statement to ensure that that you are aware of the relevant process.
We trust that you find the above to be in order.
Regards
Talksure team
We acknowledge receipt of the revised Medical Scheme statement and this has been provided to the Claims division for reassessment of the claim; they have indicated that feedback can be expected within the next 7 to 10 working days.
We trust that you will find the above to be in order.
Regards
Talksure team
We acknowledge receipt of the revised Medical Scheme statement and this has been provided to the Claims division for reassessment of the claim; they have indicated that feedback can be expected within the next 7 to 10 working days.
We trust that you will find the above to be in order.
Regards
Talksure team