LP
Lauren P
1 reviews | Active since Feb 2024
20 May 2024, 08:09
Claim
After a month of all confidential notes requested from my dr for my procedure, yet Gap cover declines my claim. The doctor confirmed in writing that my surgery was not a pre-existing condition, my condition was not known before march 20204 yet you guys still decline my claim and medical aid approved my procedure as it was not a pre-existing condition.
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Replies (6)0
Replies (6)
Zestlife's replyOfficial
20 May 2024, 08:25Dear Lauren,
We have a team of specialist who carefully analyse and consider all the facts at hand when they make a decision regarding a pre-existing condition.
Our Claims Committee will have a look at your claim and related facts to reassess whether they are in agreement with their decision and will provide you with feedback during the course of today.
Kind regards
We have a team of specialist who carefully analyse and consider all the facts at hand when they make a decision regarding a pre-existing condition.
Our Claims Committee will have a look at your claim and related facts to reassess whether they are in agreement with their decision and will provide you with feedback during the course of today.
Kind regards
Zestlife's reply20 May 2024, 08:25
Official
Dear Lauren,
We have a team of specialist who carefully analyse and consider all the facts at hand when they make a decision regarding a pre-existing condition.
Our Claims Committee will have a look at your claim and related facts to reassess whether they are in agreement with their decision and will provide you with feedback during the course of today.
Kind regards
We have a team of specialist who carefully analyse and consider all the facts at hand when they make a decision regarding a pre-existing condition.
Our Claims Committee will have a look at your claim and related facts to reassess whether they are in agreement with their decision and will provide you with feedback during the course of today.
Kind regards
LP
Lauren P's updateReviewer Update
20 May 2024, 09:10So the clinical team is above the doctor's that stated my condition is not pre-existing?
LP
Lauren P's update20 May 2024, 09:10
Reviewer Update
So the clinical team is above the doctor's that stated my condition is not pre-existing?
LP
Lauren P's updateReviewer Update
20 May 2024, 13:20If this claim does not get resolved and paid by Wednesday, I will have the ombudsman involved and a lawyer as well as the doctor confirmed in writing my condition was not pre-existing one
LP
Lauren P's update20 May 2024, 13:20
Reviewer Update
If this claim does not get resolved and paid by Wednesday, I will have the ombudsman involved and a lawyer as well as the doctor confirmed in writing my condition was not pre-existing one
Zestlife's replyOfficial
20 May 2024, 13:46Dear Lauren,
As stated in my first reply, we will get back to you today regarding our final opinion.
Kind regards
As stated in my first reply, we will get back to you today regarding our final opinion.
Kind regards
Zestlife's reply20 May 2024, 13:46
Official
Dear Lauren,
As stated in my first reply, we will get back to you today regarding our final opinion.
Kind regards
As stated in my first reply, we will get back to you today regarding our final opinion.
Kind regards
LP
Lauren P's updateReviewer Update
20 May 2024, 20:07A full day has gone by no feedback. I am logging a complaint with the FSCA all correspondence and confirmation in writing confirming condition was not a pre-existing one
LP
Lauren P's update20 May 2024, 20:07
Reviewer Update
A full day has gone by no feedback. I am logging a complaint with the FSCA all correspondence and confirmation in writing confirming condition was not a pre-existing one
Zestlife's replyOfficial
21 May 2024, 04:52Dear Lauren,
We have provided you with detailed feedback and facts proofing the pre-existing condition.
We respect your right to log a complaint with FSCA.
We understand that this is not the outcome you were hoping for, but can only pay valid claims.
Kind regards
We have provided you with detailed feedback and facts proofing the pre-existing condition.
We respect your right to log a complaint with FSCA.
We understand that this is not the outcome you were hoping for, but can only pay valid claims.
Kind regards
Zestlife's reply21 May 2024, 04:52
Official
Dear Lauren,
We have provided you with detailed feedback and facts proofing the pre-existing condition.
We respect your right to log a complaint with FSCA.
We understand that this is not the outcome you were hoping for, but can only pay valid claims.
Kind regards
We have provided you with detailed feedback and facts proofing the pre-existing condition.
We respect your right to log a complaint with FSCA.
We understand that this is not the outcome you were hoping for, but can only pay valid claims.
Kind regards