Underwriter accountability: Administrator denying “unlimited” GP access for a child with no reasons

I am escalating my concerns to the underwriter (Centriq Insurance Company Limited) because the administrator, Kaelo, is administering this policy in a way that is unfair and lacks transparency.

My young child had flu symptoms during seasonal change. When we called for authorisation for an in‑person GP visit, Kaelo denied the benefit. No clinical reason was provided — the only response given was: “Authorisations are subject to Managed Care Protocols.” That is not a proper explanation, and it contradicts how the benefit is marketed as “unlimited”.

Instead, we were told a clinical nurse would contact us. The nurse only called almost 4 hours later, which is unacceptable when dealing with a sick child. We did not ask for a nurse call — we needed a GP to examine the symptoms and prescribe correct medication.

This was not “excessive claiming”. The previous claim was unrelated to this flu incident.

When we called to cancel because this cover clearly does not meet a child’s healthcare needs, we were told the policy will only terminate at the end of April. Why must we remain on cover that fails when we need it?

We have also had a recent scan rejected without proper justification.

Request: I want the underwriter to review Kaelo’s handling of benefits and provide (1) written clinical reasons for the GP denial with the specific protocol re**** on, (2) clear turnaround standards for nurse callbacks, (3) proper justification for rejected claims, and (4) written confirmation of cancellation date and last debit date.