EB
Estelle B

1 reviews | Active since Jan 2015

14 Sept 2017, 12:32

Rejection of Claims x 3

When I originally signed up about 4 years ago I was only on the Heli Rescue Plus then upgraded to the Hospital Protect. The upgrade was done last year around September 2016. I only wanted the plan for my daughter who was 17 and they said I cant so I was the main member and included her on this plan. I was very open and explained her condition to them informing them that she is Cerebral Palsy and was diagnosed with Asthma at that stage. She was to be discharged as she has been asthma clear. However in December last year she got very sick and was hospitalised with pneumonia. In February this year they did a milk scan and other scans and picked up that her food was going into her lungs. This was a big shock for me and as I fed her for 18 yrs, it was hard for me to accept. Nevertheless they put her on thickened foods and then in April her conditioned worsened and I had to make a decision for them to do a gastrostomy, which was scheduled for May 2017. I called the unlimited and told them about this decision and they said that I am past the waiting period at end April and I am elligible to claim. She had the operation and was in hospital from 2 -5 and left on bolus feeds, two days later it did not agree with her and she was readmitted on the 7 May until the 10 May. It was then decided that she should remain on continuous feeds. In June she had a chest infection and was admitted from Red Cross Hospital to Groote Schuur Hospital for recovery on antibiotics on the 9 June her conditioned worsened and was transferred back to Red Cross as she had contracted hospital pneumonia. She was there until the 13 June and discharged. I have submitted the supporting documentation and now I am told that because my child is CP and very sick with a pre existing condition, there is no valid claim. My child was not admitted because of being Cerebral Palsy. The medical team at the Unlimited read the file and concluded that because she has CP which is pre existing thats why she is not elligible. When I introduced my childs condition when I signed up, NEVER was that a problem. The gastrostomy was discovered in February this year and her pneumonia was contracted while she was in recovery. I am consulting with a legal team and will be going the ombudsman route. Is this how business is conducted? Where is the human element? Also, I have witnesses when I took the call and flagged the CP condition. When I told the consultant I think I will rather be cancelling she said no you will still be able to put in a claim for yourself (main member) in the future. I said it was never about me.

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Replies (2)
The Unlimited
The Unlimited's reply14 Sept 2017, 15:07
Official

Hi Estelle, you and your daughter have been through so much. Thank you so much for letting us know about this as you have given us the opportunity to investigate. We have already asked our Claims team looking into your policy and we’ll give you a call as soon as we’ve got some answers which will be within the next 24 hours. Thanks so much, The Unlimited.

EB
Estelle B's update03 Oct 2017, 14:11
Reviewer Update
ok, so today I receive a call to say that I HAVE NEVER DISCLOSED THE INFORMATION THAT MY CHILD IS CP. They listened to the recording, so just like everything else, I must take there word! Even the times when we called for an ambulance, it is disclosed to the caller when they ask what is wrong with your child, what is the emergency. Also, despite all this they still decide to take the money off my account, knowing that they are NOT COVERING MY CHILD for the Hospital Protect. I cannot see your business growing when ripping people off is what makes you money.