Clientele Life, Hospital Cash Back Plan failed to honour the contract. On the 11/11/2013 i was admitted for Brochitis and Gastro-Enteritis and was and discharged on the 24/11/2013. After i submitted my claim i was paid for 5 days (which was short paid) instead of 13 days. Upon questioning the consultant he informed me that they have paid for 5 days only for Brochitis which they treat as Pneumonia which has limitation of 5 days. On the policy document it does not reflect so. "Hospitalisation for the investigation and treatment of any GastroIntestinal Tract Infections or diseases will be limited to a maximum of 3 days per event, after the initial 2 days of hospitalisation which is excluded from Cover. Only 1 event per 12 month period will be covered with a maximum of 3 events during the Currency of the Plan". If one ask how they culculate the number of days because i stayed period of 13 days but they only paid for 5 days. The only diagnose which they paid for was Brochitis but failed to pay for Gastro-Enteritis. and also failed to explain as to why in writing because it is not included in my policy document.
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