An excuse that won’t cover it If it says jump, ask how high
Large companies cannot blame their bad service on their size
READERS may have noticed that some companies — or industries — appear on this page a little more often than others.
On a basic level, it is down to numbers: the more customers a service provider has, the more upset ones it will produce. And naturally it is they who beat a path to my door.
But the numbers game is an all too easy out for repeat offenders. They use their size as an excuse for the scores of complaints and social media venom they generate.
If anything, size places an added onus on business to get it right. Systems need to be top class, not good. Staff need to be exceptional, not average. Customers need to be treated like individuals, not numbers.
Until that happens, major players, including banks, cellphone providers, insurers and medical schemes, will keep finding themselves under fire.
Today, both the Government Employees Medical Scheme and Discovery Health — again — come in for a lashing. And rightly so, on both counts.
KwaZulu-Natal teacher Hambisani Shabalala had his government scheme cover suspended in May following an allocation error by the scheme. Despite many attempts to resolve the problem, Shabalala got nowhere.
“I am at my wits’ end,” he wrote. “Due to the scheme’s negligence my details were incorrectly captured. In May I got an SMS informing me that my medical aid benefits had been suspended because of arrears of R10 688.”
When his eight-year-old son got tonsillitis in June, he had to visit a state hospital for treatment because he could not afford a private doctor.
More troubling is that had Shabalala or his family needed emergency care at a private hospital, authorisation would have been declined.
Liziwe Nkonyana, the scheme’s communications and member affairs executive, apologised for the “inexcusable series of events”, saying the reader’s membership had been incorrectly allocated.
“We are sorry to hear that Mr Shabalala’s son was ill and will reimburse any costs incurred by him so long as these fall within the scheme rules,” said Nkonyana.
The government scheme, which is administered by Medscheme and Metropolitan Health, has almost 690 000 principal members.
It is certainly less than Discovery’s 1.16 million members, one of whom is Johannesburg executive chef Ian Mancais, who runs a hospitality business. He was staggered to re- Lyoness rules. The 70year-old pensioner had apparently contacted Woolworths directly for gift cards, claiming to be a representative of Lyoness.
I was told by someone in Lyoness that the “modus operandi” was to scare members and that I needed to jump as high as they wanted me to if I wanted to be reinstated.
I no longer want to be
associated with
Lyoness. — The Rev Cecil James, Hermanus THANK you for your article on Lyoness. The company has ignored my repeated requests to refund R7 600 deposited with it. My demand followed the cancellation of my membership after someone I had introduced to the programme violated ceive an e-mail from Discovery — a week after his monthly debit deduction — saying that the benefits on his hospital plan had been suspended.
The e-mail warned that it had “temporarily stopped” his benefits because he was behind in payments.
“You owe us R1 350,” the
Just be straight with members and tell it like it is
e-mail stated. “You will not have any benefits until we get the outstanding money.”
It said membership would be terminated following two months of arrears.
A panicked Mancais, who had never missed a debit payment, immediately queried the suspension. Even though he had been diligent in changing his banking details online, he had unknowingly only changed the account into which his claims were paid, not the account from where his premiums were debited.
He settled the arrears instantly and the suspension was lifted. “Why on earth can’t Discovery call to give the client the opportunity to do something about it before suspension?” said Mancais. “What if I had been travelling, as I do often, and had not accessed my e-mail?”
It turns out a suspension does not mean a loss of cover at all. It just means that claims submitted during that period will not be processed until the arrears are settled.
Said chief operations officer Ryan Noach: “We would like to emphasise that the suspension of Mr Mancais’s healthcare policy did not affect the con- tinuity of his healthcare cover at any time. It is only in the case of membership terminations and withdrawals, which follow extended premium arrears and associated communication, that medical cover is interrupted,” he said.
And what about emergency cover? Well, that depends. Each case would be treated on merit, said Noach. Noncritical care would not be authorised.
In an emergency, an “immediate interim debit order facility” — whereby a patient agrees over the phone to a oneoff debit — is offered to suspended members, after which immediate hospital authorisation is provided.
If a patient is incapacitated, the same facility is provided — through an electronic funds transfer — to a family member willing to pay on the member’s behalf.
Noach said a robust process, including “transparent communication” to all members, was assured through a triedand-tested process.
“This process assures that members are treated fairly and that the financial interests of the schemes we represent are looked after,” he said.
I am not convinced about transparency. I did not see anything in the suspension e-mail or elsewhere that provided any of the assurances described above. All the e-mail did was to create panic.
It is not rocket science, Discovery. Just be straight with members and tell it like it is. Believe me, they will thank you for it.
Tune in to Power FM’s ‘Power Breakfast’ at 8.40am tomorrow to hear more from Megan