Gloria M

Gap cover that does not pay claims as they promised

Good day, I had a procedure on my back on 26 March 2025. I submitted 2 claims that were not fully covered by my medical aid. I submitted the claim on 22/04/2025 and again on 20/5/2025. I was assured that the claim had been approved. I then received a letter of repudiation on 16/7/25, saying that they do not pay if the medical aid has not paid anything. That is incorrect as the medical aid paid a portion to the doctor leaving me with R1432.10 that I must pay. The second claim to a different doctor was submitted on 19/05/25 R3567.52. The gap Administrator put the claim in for R2207.71 and paid R1379.81 into my bank account on 28/7/2025 leaving a balance of R2187.71 for me to pay. I also received an e mail from the Gap Administrator to say the claim had been approved. According to my gap cover when they receive a claim it is processed and paid within 5 working days. As you can see this took weeks before I heard that the first claim was repudiated and the second claim from May to July to pay out a portion. The gap Administrator also confessed that she forgot to process the second claim. I was **** to. Promising they were going to pay within a week. When I queried it she then said they had a problem with their system. The only income I receive is SASSA and I really cannot pay off this amount of R1432.10 and R2187.71. I have all the e nails and documents if you so wish to see. I will definitely not recommend anyone to take out gap cover with Agility