AB
Andrea B
Active since Apr 2020
4
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0
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Reviews
4 reviews10 months ago
Abysmal claims department
I was admitted to hospital for an endometriosis related procedure on 22 May 2025. Before being admitted to hospital I had to pay a penalty of R12 200 due to the hospital not being on the essential smart plan. When the hospital submitted their claim to Discovery, they excluded the R12 200. When I tried to recover this from my GAP cover, I was informed that my medical aid must reject this claim before my GAP claim can be finalized. I contacted the claims adjustment department and provided them with an extract of my credit card statement (to serve as POP), the hospital statement of account (showing I privately covered this amount) and the claim to which I wish to add this additional penalty claim. Discovery has gotten back to me providing me with the same claim that I added to my email, never adjusting for the R12 200. I find this absolutely frustrating as there is obviously no attention being paid to the support for the claim provided and the 2-3 day turnaround time is far past. This is delaying my R35k GAP cover claim from being finalized and it has been 10+ days that I have phoned and sent emails to amend the claim. This is extremely disappointing and the customer service in terrible.
112 replies
10 months ago
Terrible claims service
I am trying to finalise a GAP cover claim with Kaelo GAP cover. I was admitted to Life Vincent Pallotti for surgery on 22 May 2025 and had to pay an admission fee of R12 200 since the hospital is not on my plan. Needless to say, Kaelo knows what medical aid I am on, and I also sent them the policy from my medical aid about the penalty because the hospital is not on my plan. It is quite self-explanatory that the medical aid would not cover this amount. I sent them the statement of account showing that I privately paid this together with the medical aid policy stating the amount of the penalty. The hospital never submitted this co-payment to my medical aid due to the fact that it is a penalty payable upfront and will not be covered by my medical aid. As a GAP cover service provider Kaelo should know this, but instead are delaying the GAP claim finalisation regardless of ample support for the claim. Together with this I also got an email requesting all the documents I had already submitted on the website when initiating my claim - I also had to phone them to clarify this issue. It seems like very little care or pride is taken by the reviewers when reviewing a claim. I pay my monthly premium on time and in the past 4 years of doing so, this is my first time trying to claim. The service and lack of proper review and application of common sense is shocking.
56 replies
10 months ago
Abysmal Finance Department
I was admitted to Life Vincent Pallotti hospital on 22 May 2025. Because I am on the Discovery Essential Smart Plan, I had to make an upfront payment upon admission of R12 200 since this particular hospital is not on my plan. Whilst I was fully aware of this, the hospital did not indicate this amount as a deductible on the claim sent to my medical aid. I picked this up when I wanted to submit my GAP cover claim for all expenses related to my surgery that were not covered by my medical aid. I contacted the Life Hospital Administration via email and telephonically on 17 June 2025 to request that they resubmit the claim correctly, so I can finalise my GAP cover claim, which is a significant sum of money. I explained to them that I need this claim to be correctly submitted to my medical aid so that I can get the rejection code from my medical aid to submit to my GAP cover. The lady I spoke to escalated this matter on 25 June 2025 to the finance department (after no additional communication since her request to them regarding the claim on 17 June). This was also only after I phoned again to follow up as well as send an email. I still have not heard back from them and they have been ignoring all further emails regarding this situation. This is causing a significant delay in the finalisation of my GAP cover claim and is proving to be very frustrating.
0 replies
73 months ago
Contiki Exploits customers' options to cancel trips
I emailed Contiki consultant Yanda Mongo on 05 March 2020 about what will be happening with the tour that I booked for 26 June 2020 with regards to COVID-19, they said that they are looking at it on a month to month basis and will get back to me. Yesterday consultant Leeanne Naidu sent an email giving us two options. To either travel in 2020/2021 or to get travel credit until 30 December 2022. I responded by explaining that in the second week of March via telephone the consultant told me that I can cancel and get my money back, just losing my deposit. Please keep in mind that I am a third year student planning on doing honours, masters and my articles in the next five years and I was planning that the only dates I have available would be June 2020 for travel. Therefore the dates they had given to me does not fit my calendar. They responded by saying I have to choose one of the options they had given me yesterday. They have failed to understand that they gave me other options before their decision yesterday and completely disregard my rights and options as consumer. I expect of them to give me the option of cancelling my trip, because I was able to do so before the pandemic and see no reason why I may not and cannot do so now. I am also in contact with ASATA to take steps against them.
0 replies
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4 (100%)