Bankmed confirmed payment of claim then backtracks as a mistake.

Disappointed in Bankmed. After many months of back and forth, confirming payment of a csection, only R4855,70 was paid out of R25000 (on a comprehensive plan). I requested calls and transcripts (nothing provided after almost 3 weeks). I spoke with consultants and on Friday 11th June, Rishen confirmed that the outstanding amount could come from my MSA. Double checking he called me back stating the procedure codes were not a PMB and that I could submit a special request to get the funds paid from MSA. I completed the form, submitted, got a reference number and he called me back a 3rd time to confirm and obtain the reference number. It was sent to Yusuf to assist with as Rishen would be on leave. On Tuesday 15th I get a call from Yusuf stating this would not be paid from MSA, they made a mistake. I escalated. Aliya called me back and tried to assist, noting that they confirmed they would pay my claim. After escalating to her managers it was declined. I am still waiting for transcripts of my calls. 3 weeks to escalate from 1st day of phone call is unacceptable. Confirm with a client that you will pay a claim and then backtracking on that is unacceptable. I ask for this to be escalated to the escalation team to be told a CRM will call me. I want the escalation department to call me and resolve this. I want my transcripts because I will be going to the ombudsman And council for medical schemes (I was told they won’t give me my transcripts, they will give it to the ombudsman on request).

If a medical aid confirms to pay something, it’s unacceptable that they backtrack because they made a mistake. Bankmed you should honor your payment confirmations with your clients whether from MSA or scheme. If you made a mistake you cannot expect the client to suffer the consequences of your failure. You said you would pay, honor that.

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