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Jolene S

1 reviews | Active since Apr 2020

08 Apr 2020, 03:22

This is the WORST insurance company you would want to insure your loved ones with. The claims process is RIDICULOUS. I actually want to know where can I go to lay a compliant or could someone help me to take them to court or get them fined or better close

HEP059259 R2 000 a day, for up to 10 days in hospital. This increases to R3 000 a day if you’re admitted to ICU. This covers you for up to 3 admissions per year. (R20 000) Death benefit of R10 000 Mom admitted to Tswane district hospital 6 December 2019 She was then transferred to Steve Biko Hospital on 13 December 2019 She died on 18 December 2019 at Steve Biko Hospital Her funeral was on the 27th December 2019 She was cremated only early January 2020 due to the fact that we had to get the money together. I then received the claim forms that needed to be completed by her treating Dr as well as a long list: I explained to them that my mother didn't have medical aid, she couldn't afford private healthcare as a result was using government facilities (Clinic). Copy of the Nursing Notes Account Statement and Discharge Summary from the Medical Facility where the insured was admitted into reflecting the date and time of admission and discharge as well as the final diagnosis and all procedures performed and medication administered. (This is only needed in the event of an admission into a Government / State Hospital) • Copy of the FULL computer-generated Hospital Statement reflecting the date and time of admission and discharge, ICD Codes, medication administered and procedures performed. (This is only needed in the event of an admission into a Private Hospital) • A detailed letter from the treating Medical Practitioner / Specialist for all admissions longer than 3 (three) days motivating the length of stay as well as well as advising of the final diagnosis and long term prognosis. • All X Ray / CT Scan / ECG / Ultrasound Reports • Copy of the Policy Holder’s Identity Document • Certified Copy of the Patient’s Identity Document • Copy of all Blood Results / reports • Bank Statement / Confirmation of Banking Details from the Bank reflecting • Full Name of Bank Account Holder • Bank Account number, Name of Bank and Branch Code I then went to Steve Biko Hospital with the claim documents There I was told that 1st of all if my mom was still married to my dad (and she was) my dad would have to come with his original or certified marriage certificate because only him can submit the claim (even though on her policy no one specific was appointed as beneficiary and according to Unlimited I had to / can go on with claim as I enquired first and I am a relative (oldest daughter) Also for us to get all the files would cost about R1600 at Steve Biko Hospital & Tswane asked R480 for their documents (Payable when the files are ready) So my dad had to take off work (he gets paid per hour) to go to department of home affairs and court to get a valid copy of their marriage certificate I then took my dad (who had to take off work again) to Steve Biko Hospital with the documents. Then we were told we had to get a letter of authorisation from the Magistrates court for them to release the (copy) files. My dad had to take off work again and we went to court. They said we are at the wrong court, we must go to the Master of the High court. The next day 3 February 2020 this is what was happening: News24 Masters' offices shut as SIU conducts countrywide raids 2020-02-03 20:32 Alex Mitchley Offices of the Master of the High Court across the country was temporarily closed after the Specialised Investigating Unit (SIU) began search and seizure operations on Monday afternoon. Justice and Correctional Services Minister Ronald Lamola said the raids on 15 offices came about after President Cyril Ramaphosa authorised an investigation into allegations of countrywide maladministration, *******ion and *****….

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Replies (3)
The Unlimited
The Unlimited's reply08 Apr 2020, 08:27
Official
 
Hi Jolene, 
 
 
Please accept our sincere condolences to you and your family on the passing of your mother. We understand that this is a difficult time for you and we're troubled to hear that this has been your experience with us. Our claims department will contact you shortly to look into your claim query and assist you. 
The Unlimited
The Unlimited's reply09 Apr 2020, 08:40
Official
 Hi Jolene, 
 
 
We have contacted you, however, we've reached your voicemail. Please inbox us your alternative number that we can use to reach you. 
The Unlimited
The Unlimited's reply14 Apr 2020, 12:14
Official
Hi Jolene, 
 
 
Thank you for taking our call today. We will proceed with the assessment of your claim as soon as we've received the outstanding documents.