JP
Jomar P
1 reviews | Active since Feb 2020
04 Nov 2020, 17:17
Pathetic GAP Cover - Total Risk Adminitrators
Submitted a claim for a co-payment which they rejected and decided it should be paid out of my pmb benefits from my medical aid. Confusion? Thought GAP covers were created for peace of mind when medical aids does not cover costs? No where have I seen or signed a disclosure stating pmb benefits shortfalls are not covered. Reason code 26 according to them possible pmb? Who gave TRA the right to decide allocations for the medical aids? I moved from another gap cover due to pathetic service now I am getting even worst service at least they paid even if it was short and I had to fight to get the balance paid. Taking this up with the ombudsman because TRA is *****ing from me. Taking membership fees on time every month yet refusing benefits. I am sick and tired of these pat ethic service providers. Stay away from them people they are waisting your money and time.
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Replies (6)
Total Risk Administrators's replyOfficial
04 Nov 2020, 19:27Good Day Mr Plaatjies. Thank you for your review. We are distressed to hear about your experience as this is not the customer journey we strive for and we can assure you that we are not in the business of just taking premiums and not paying benefits for random reasons. We will investigate and get back to you asap. TRA Management.
Total Risk Administrators's reply04 Nov 2020, 19:27
Official
Good Day Mr Plaatjies. Thank you for your review. We are distressed to hear about your experience as this is not the customer journey we strive for and we can assure you that we are not in the business of just taking premiums and not paying benefits for random reasons. We will investigate and get back to you asap. TRA Management.
Total Risk Administrators's replyOfficial
06 Nov 2020, 08:24Good Day Mr Plaatjies. We tried to contact you yesterday. I want to assure you that we have not rejected your account but are asking for more information regarding your injury. We have emailed your medical aid and have included you in the email. We would appreciate if you can forward their response as they might not react to our email due to the Protection Of Private Information Act (POPI . TRA Management
Total Risk Administrators's reply06 Nov 2020, 08:24
Official
Good Day Mr Plaatjies. We tried to contact you yesterday. I want to assure you that we have not rejected your account but are asking for more information regarding your injury. We have emailed your medical aid and have included you in the email. We would appreciate if you can forward their response as they might not react to our email due to the Protection Of Private Information Act (POPI . TRA Management
JP
Jomar P's updateReviewer Update
06 Nov 2020, 08:47Good day I have sent all the information requested because I was advised that I should send written proof that the medical aid refuses to pay the co-payment however shortly after sending the proof received another mail from Gift stating something else. I have received 4 different communications yesterday from 4 different consultants and have been on the phone with them all day and no one seems to communicate the same information. Highly disappointed in the incompetence received.
JP
Jomar P's update06 Nov 2020, 08:47
Reviewer Update
Good day I have sent all the information requested because I was advised that I should send written proof that the medical aid refuses to pay the co-payment however shortly after sending the proof received another mail from Gift stating something else. I have received 4 different communications yesterday from 4 different consultants and have been on the phone with them all day and no one seems to communicate the same information. Highly disappointed in the incompetence received.
Total Risk Administrators's replyOfficial
06 Nov 2020, 10:07Good Day. Thank you very much for the information that we have received from you. We do apologise for the inconvenience caused and understand your frustration. We have submitted your claim for processing and the money will reflect in you bank account next Thursday. TRA Management
Total Risk Administrators's reply06 Nov 2020, 10:07
Official
Good Day. Thank you very much for the information that we have received from you. We do apologise for the inconvenience caused and understand your frustration. We have submitted your claim for processing and the money will reflect in you bank account next Thursday. TRA Management
JP
Jomar P's updateReviewer Update
06 Nov 2020, 10:17Thank you very much it is highly appreciated. Apologies for my inconvenience caused as well but for some reason this is the only way one get through to Management and get the proper assistance needed. TRA Management keep up the good work.
JP
Jomar P's update06 Nov 2020, 10:17
Reviewer Update
Thank you very much it is highly appreciated. Apologies for my inconvenience caused as well but for some reason this is the only way one get through to Management and get the proper assistance needed. TRA Management keep up the good work.
Total Risk Administrators's replyOfficial
06 Nov 2020, 10:25It is always a pleasure to assist where we can! Have a good day. TRA Management
Total Risk Administrators's reply06 Nov 2020, 10:25
Official
It is always a pleasure to assist where we can! Have a good day. TRA Management