Thinking you will have quality health assistance, What a scam
Every prescription gets rejected. Simple response, not on the formulary. No alternatives were offered either. For some medication there is just no alternative.  They always have a story why medication is not paid or partially paid.  Some medication they say is chronic even while a Specialist or even Internist have prescribed it and you are not on the medication for a period of 3 months or longer they think they know best and say that it falls under chronic or its not part of the formulary.  Have you ever thought that some medication have side affects and thus you CAN NOT use an alternative?  You pay an enormous fee monthly and then you are only allowed to use network doctors and then they decide whether or not the medication is "formulary" prescribed? And then have the audacity to just say "oh sorry it doesn't form part of the formulary"    They have absolute no respect for clients well being or their financial well being as long as we fork up they give us the bear minimum.  I have paid more additional costs than what they have covered.  Co-payments for treatments or seeing a specialist is ridiculous they do not even cover 50% .  Trying to get my medication under "chronic" as they say its not acute guess what they do not even cover "the condition/medication.  So what are we left with?? Fork out your monthly payment, co-payment for visiting the doctor, pay your medication cash.   So overall you have spent almost R1800 plus for medication & Dr co payment oh yes and a great monthly installment of R 3800.  So think about it, is this company really worth your hard earned money?  At the end of the day invest in your health and get a company that not in it for money but actually for a service as well as your health.  Don't be fooled even with hospitalizations they do not cover Anesthesia (due to the formulary) very little day to day costing, no physio or rehabilitation ,  O yes and guess what the doctor?? You will have to settle his bill as well with no assistance from them.  Be careful when you are in an emergency you will not have the ability to receive quality care due to the fact that you will have to fork out the money yourself. Claiming doesn't even help they cover little to none