lP
lerato P

1 reviews | Active since Nov 2014

05 Aug 2019, 21:47

Bankmed not wanting to pay hospital claims

I was admitted to Netcare Clinton hospital on the 20th June. Bankmed approved my authorization on the 20th, declined it on the 21st June and approved it later that day again. On the 3rd of July, Bankmed then proceed to grant the hospital another authorization. Bankmed then backtracked on the 4th July and sent another decline following the authorization, 9 days after I was discharged from the hospital. Based on these circumstances, I would like to enquire on protocol and if this is in actual fact procedure. I was never afforded the opportunity to weigh my options whilst considering my financial standing to evaluate if it would be economically tangible to continue with in-hospital treatment in spite of the need or opt for out-patient care to avoid incurring unplanned medical costs. I am now in the unfortunate and inconvenient position of being informed that I am now liable for all medical costs. I find this to be completely unfair especially considering that Bankmed had initially authorized this stay prior to the back and forth. Should I not have been informed of my options timeously?

It’s medical aid’s job to communicate about authorizations. Yes, the hospital should have also told me about the back and forth however I'm in the mess because of Bankmed. Bankmed must pay because of the confusion caused by the back and forth and they must explain if it is procedure to accept and decline on so many occasions

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Replies (1)
Bankmed
Bankmed's reply06 Aug 2019, 08:26
Official
Hi Lerato, 

We are sorry to hear of your service experience. We have your details on record, we'll be in touch as soon as possible to provide clarity and assist regarding your preauthorisation query. 

Regards,
Bankmed Service Team