Bankmed Medical Aid

My wife has been admitted to Jakaranda Hospital with a mental condition because of long Covid on 14 January -2nd February 2022. Hospital authorisation were given and claim submitted for payment to the hospital . We belong to this medical aid since 2007 and this were the first hospital admission claim made .The bill came out to R 50 000; for the 21 days admission for mental illness. I received a an invoice from the hospital stating that only R 14000.00 has been paid and there is an outstanding amount of R 35000.00 , that’s when my problems start .The system apparently only authorise 6 days yet Bankmed own rules for mental illness states 21 days .I called Bankmed on the following dates :1st, 14th, 16th,17th,23,25,28 and 30th March to enquire about the claim .Everytime I was told that there is an error and the functional head should authorised manual payment , I fail to understand that a manual payment can take almost a month to be finalised, I really feel sorry for the consultants who must deal with customers frustrations because of the arrogance of these functional heads who get huge bonuses. The poor consultants told me that the case has been escalated on the 9th , 14th , 16, 17 March which clearly shows that they try to resolve the case but need authorisation from these functional heads that act if the funds are theirs . I’ve been a member of Bankmed since 2007 and every month they religiously deduct the membership fees . When I called this morning, 30th March , I was put through to the Team leader and after a lengthy holdup were told that the functional head , whoever he or she is are there and are looking into the matter .They only look into the matter because I told them I want answers today because the hospital threatened to hand me over to debt collectors and will also list me on the credit buro through no fault of mine . This will impacted negatively on my credit history , I raised this issue with the consultants and they could not give a solution . Needless to say these functional heads are arrogant and treat us with total disrespect .

I also intend to lodge a formal complaint with the medical aid ombudsman, this is totally unacceptable,