1 reviews | Active since Member
This company is not being ethical in their claims process. My out of hospital claim was approved after an extremely lengthy process via an Ex Gratia committee. I received a letter of approval from them, but when I sent the details for the claim to be paid out, I was told that the claim was not processed by the PPN. I resubmitted the documents requested, and was assured that it should be sorted out within a week. Only to find out later that they did not intend to pay. Upon follow up, I received a cold shoulder from the Escalations department telling me that the dates did not correlate and that the claim would not be paid. Upon asking for more information, I am being ignored. It appears that they are hiding behind inane bureaucracy to avoid paying out a claim that was approved. I received the approval in May, and it's many months later with still no clarity. I do not understand how they can blame the client and just refuse to pay, I have never misrepresented my case and have all the evidence to prove it. They are using stalling tactics and bureaucratic loopholes to avoid providing a promised service to the client. I am hoping someone could advise me on further action? Is this something I can appeal to the Ombudsman for?