JB
Julius B
1 reviews | Active since Aug 2012
07 Jan 2023, 11:09
TRA GAP Cover - Never again
I also have the highest cover but this is the worst company I have ever dealt with before. They do not pay for any shortfalls and almost every claim submitted to the was rejected. They always have an excuse for not paying any claims. Be aware of their policy wording as I would not recommend this company to my enemies.
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Replies (2)
Total Risk Administrators's replyOfficial
07 Jan 2023, 23:38Good Day Julius. We are sorry that this is your experience. Please email us at *** with the specific uncovered shortfalls and rejected claims and we will gladly investigate these. Regards. TRA Management
Total Risk Administrators's reply07 Jan 2023, 23:38
Official
Good Day Julius. We are sorry that this is your experience. Please email us at *** with the specific uncovered shortfalls and rejected claims and we will gladly investigate these. Regards. TRA Management
Total Risk Administrators's replyOfficial
12 Jan 2023, 11:47 Good Day Julius
The claims dated 09.12.2022 was received on a claim import file from your medical aid. According to the ICD 10 code used by the providers, this might be a possible PMB (Prescribed Minimum Benefit) claim. According to the CMS (Council of Medical Schemes), if the criteria are met, all PMB related claims must be paid in full by the medical aid. The claims were not rejected, we merely requested more information. We have escalated the claims on your behalf to your medical aid to enquire if any further payment will be made as a PMB.
Regarding the service date 06.10.2022, one of the tariff codes was rejected by your medical aid as not covered, please contact your medical aid to resolve this with them as no payment was made on this code. The medical aid also informed you that the service provider needs to adjust the account as the billing was incorrect.
We value our Policyholders and the service that we give to you. TRA Management
The claims dated 09.12.2022 was received on a claim import file from your medical aid. According to the ICD 10 code used by the providers, this might be a possible PMB (Prescribed Minimum Benefit) claim. According to the CMS (Council of Medical Schemes), if the criteria are met, all PMB related claims must be paid in full by the medical aid. The claims were not rejected, we merely requested more information. We have escalated the claims on your behalf to your medical aid to enquire if any further payment will be made as a PMB.
Regarding the service date 06.10.2022, one of the tariff codes was rejected by your medical aid as not covered, please contact your medical aid to resolve this with them as no payment was made on this code. The medical aid also informed you that the service provider needs to adjust the account as the billing was incorrect.
We value our Policyholders and the service that we give to you. TRA Management
Total Risk Administrators's reply12 Jan 2023, 11:47
Official
Good Day Julius
The claims dated 09.12.2022 was received on a claim import file from your medical aid. According to the ICD 10 code used by the providers, this might be a possible PMB (Prescribed Minimum Benefit) claim. According to the CMS (Council of Medical Schemes), if the criteria are met, all PMB related claims must be paid in full by the medical aid. The claims were not rejected, we merely requested more information. We have escalated the claims on your behalf to your medical aid to enquire if any further payment will be made as a PMB.
Regarding the service date 06.10.2022, one of the tariff codes was rejected by your medical aid as not covered, please contact your medical aid to resolve this with them as no payment was made on this code. The medical aid also informed you that the service provider needs to adjust the account as the billing was incorrect.
We value our Policyholders and the service that we give to you. TRA Management
The claims dated 09.12.2022 was received on a claim import file from your medical aid. According to the ICD 10 code used by the providers, this might be a possible PMB (Prescribed Minimum Benefit) claim. According to the CMS (Council of Medical Schemes), if the criteria are met, all PMB related claims must be paid in full by the medical aid. The claims were not rejected, we merely requested more information. We have escalated the claims on your behalf to your medical aid to enquire if any further payment will be made as a PMB.
Regarding the service date 06.10.2022, one of the tariff codes was rejected by your medical aid as not covered, please contact your medical aid to resolve this with them as no payment was made on this code. The medical aid also informed you that the service provider needs to adjust the account as the billing was incorrect.
We value our Policyholders and the service that we give to you. TRA Management