1 reviews | Active since Mar 2021
Not to be recommended at all.
I had a back operation in January of 2020. Before surgery I had to pay Doctor Stegman an amount of R 16,442-90. I had to pay with my credit card as I did not have such an amount on me. I tried to claim this co-payment from TRA with no success at all. They did not even come back to me. An amount of R12,540-00 is still owing to the hospital where the operation took place. I thought I was going to get help from TRA. They kept on sending me back to the Medical Aid and had all the excuses not to pay. During the month of April, 2020 I had 2 heart attacks which resulted in a by-pass operation. My Medical Aid paid for most of it except for an amount of R 31,143-15. I approached my "GAP COVER". I was told by Venus on the phone that I took the wrong option when I took out this cover 5 years ago. (FIVE YEARS OF PAYING MY "GAP COVER" FAITHFULLY WITHOUT SKIPPING ONE PAYMENT.) When taking out this insurance, you are not told about options. I am sorry, but I can NOT recommend this company to anyone at all. When it comes to payment, they have all the excuses and no Gap Cover is available. I paid all that money for nothing. What a pity that these insurance companies get away like that.
We are sorry to hear about your experience regarding the submitting of claims.
After some investigation we gathered that there were a few tariff/procedure codes that was declined by your medical aid. The treating Doctor and yourself were informed by the medical aid that they will not cover the full procedure and you might be liable for some of the account. You were informed by the Customer Care Department of TRA that if your medical aid does not cover tariff codes or modifiers, TRA cannot cover this as we are not allowed to take over the role of your medical aid. May I suggest that it might be in your interest to contact your medical aid and query why the codes were declined.
I do apologise as I see that the co-payment on the hospital account were never processed and refunded to yourself. This was submitted today for urgent processing and payment will reflect in your bank account on Thursday. Once again please accept my sincerest apology.
The claims for your procedure on 21.04.2020 was a emergency PMB (Prescribed Minimum Benefit) and as per the rules of the Council of Medical Schemes, this account must be paid in full. Based on the authorisation letter you were admitted on 20.04.2020 at 16h12 and the operation and authorisation was only obtained and done on 21.04.2020. This qualifies as an emergency PMB. Please contact your medical aid.
We have emailed you your Policy Document reflecting your benefits and information on what you are covered on 27.11.2018, 25.11.2019 and 14.11.2020 providing you with information on your Policy and giving you the opportunity to upgrade to a higher option with full coverage should you wish to do so.
If there is anything that we can assist you with, please do not hesitate to contact us
TRA Management
We are sorry to hear about your experience regarding the submitting of claims.
After some investigation we gathered that there were a few tariff/procedure codes that was declined by your medical aid. The treating Doctor and yourself were informed by the medical aid that they will not cover the full procedure and you might be liable for some of the account. You were informed by the Customer Care Department of TRA that if your medical aid does not cover tariff codes or modifiers, TRA cannot cover this as we are not allowed to take over the role of your medical aid. May I suggest that it might be in your interest to contact your medical aid and query why the codes were declined.
I do apologise as I see that the co-payment on the hospital account were never processed and refunded to yourself. This was submitted today for urgent processing and payment will reflect in your bank account on Thursday. Once again please accept my sincerest apology.
The claims for your procedure on 21.04.2020 was a emergency PMB (Prescribed Minimum Benefit) and as per the rules of the Council of Medical Schemes, this account must be paid in full. Based on the authorisation letter you were admitted on 20.04.2020 at 16h12 and the operation and authorisation was only obtained and done on 21.04.2020. This qualifies as an emergency PMB. Please contact your medical aid.
We have emailed you your Policy Document reflecting your benefits and information on what you are covered on 27.11.2018, 25.11.2019 and 14.11.2020 providing you with information on your Policy and giving you the opportunity to upgrade to a higher option with full coverage should you wish to do so.
If there is anything that we can assist you with, please do not hesitate to contact us
TRA Management