CV
Clinton V
Active since Jan 2021
3
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Reviews
3 reviews2 months ago
Complaint: Unjustified Decline of Hospital Authorisation
I would rate them 0 stars if that was an option. On 5 February 2026 at 00:30, I submitted an urgent request for hospital authorisation, as my wife was required to be admitted the following day (6 February 2026) on the advice of her maxillofacial surgeon. This urgency followed a month-long course of treatment during which she had consulted both a dentist and a maxillofacial specialist on numerous occasions due to the severity and complexity of her condition. Based on the specialist’s recommendation and the clinical urgency of the procedure, the hospital bed and anaesthetist were provisionally pre-booked, pending authorisation approval. This is standard practice for urgent cases and further underscores the seriousness and time-sensitive nature of the situation. Despite the clear clinical history and urgency, the authorisation request was declined without any meaningful assessment of her prior claims, treatment history, or the nature of the procedure. The rejection consisted of a generic response that lacked clinical justification or a substantive outcome. I immediately lodged an appeal and submitted a detailed, in-depth medical motivation from the treating doctor, clearly outlining the necessity for hospital admission and the requirement for the procedure to be performed under anaesthesia. On 5 February 2026, I contacted Denis four times telephonically, explicitly requesting a call-back from a manager or team leader to address the matter urgently. Despite these requests, no one contacted me. This lack of response is unacceptable, particularly given the medically urgent and pre-scheduled nature of the case. As a result of this failure in service, I have formally submitted complaints to: The Council for Medical Schemes, DENIS, Medscheme and Polmed. As paying members, we are entitled to competent, responsive, and accountable service. The level of inefficiency, lack of communication, and apparent disregard for patient well-being demonstrated in this matter reflects poorly on DENIS as a managed care provider. The volume of similar complaints and consistently poor ratings on platforms such as Hellopeter further reinforce this concern. It is deeply concerning that medical schemes continue to make use of managed care providers whose clients express such widespread dissatisfaction. This matter requires attention at a broader level, including engagement through Annual General Meetings and union representation, to ensure accountability and the removal of persistently underperforming service providers.
56 replies
64 months ago
Excellent Customer Service:Tasmina Nair
Required amendments to be done to my policy and Tasmina from the Retentions Department Sandton, was of great assistance. She was very professional and showed great work ethic.A definite asset to her organisation. Keep up the good work Tasmina!.
56 replies
64 months ago
Excellent customer service : Tasmina Nair
Required amendments to be done to my policy and Tasmina from the Retentions Department Sandton, was of great assistance. She was very professional and showed great work ethic.A definite asset to her organisation. Keep up the good work Tasmina!.
0 replies
Review Distribution
5 Star
2 (66.66666666666667%)
4 Star
0 (0%)
3 Star
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2 Star
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1 Star
1 (33.333333333333336%)