1 reviews | Active since Apr 2010
Bankmed refusing to pay to have 3 year old's teeth extracted under General Anaesthesia
Good day I would like to lodge a complaint against Bankmed, I am not at all happy with the response or service I received from Bankmed. We are on Bankmed Core Saver Membership number ********** 10 My 3 year old son has severely damaged front teeth, we took him to the dentist when the teeth started chipping , the dentist took X rays and informed us that there is no life in the 4 front teeth and they need to be extracted, with him being so young they will need to do it in a theatre as he is to small to control in the chair and the trauma will be a lot for him, Apart from the teeth breaking he is continiously geeting absesses in his gums due to the damaged teeth which is causing health issues and might affect the permanent teeth. Bankmed refuse to fund the procedure and just declines it on the base that it is not a PMB, stating that the plan we are on does not cover dentistry apart from PMB or otherwise from the savings account. I highly doubt it that there is a savingsplan out there that can foot the bill of a hospital account. That being said this is not a normal request as my current medical savings balance would easily cover the cost if it could be done in the chair, but it cannot and I truly believe my medical aid should assist as this is not a everyday occurrence. I can find multiple medical aids out there that can and will cover the procudere, but a employment condition binds me to Bankmed, as such I have no choice which medical aid I want to use, with this I feel that they should assist as I have no alternative, I can not leave them and they very well know it, and as such they should be able to make certain consessions towards their members as they are assured as long as we are in the employ of FNB they will get their membership fee, as we have absolutely no say in how they structure our plans or in the premiums they charge. I can upgrade to a higher plan at a increase of over R3000 pm which makes it unaffordable for my Family and then they want to apply a 6 month waiting period to this aswell making the upgrade useless, I can swith to another medical aid which charges a R1000 more than what I currently pay with better benefits and they pay dental expenses to the amount of R25000, which is way better than what bankmed offers me, but I don’t have a choice I cannot switch I am really upset with the unwillingness of my medical aid in refusing treatment, everyday we wait just damages my son’s teeth even more, this is a once of request and they could not be bothered to assist, they know we do not have alternatives and can do as they please, they should look for ways to assist instead of just decline requests, there are guidelines I understand but its not set in stone and there are ways to assist. Paying a R15000 hospital bill won’t bankrupt them, but it will assist a 3 year onl member in improving his health and possibly save a lot of costs that might come from the continued use of antibiotics to control the absesses, and damage it might cuase in other parts.
Hi Leonard
We’ve confirmed with that our Medical Advisors has reviewed your request and declined funding as the diagnosis supp**** by the treating Doctor was not a Prescribed Minimum Benefit. We recognise that the treating doctor is in the best position to make medical decisions regarding the treatment options available. In reaching this decision we have not questioned the diagnosis or the treatment recommended by the treating doctor.
As a healthcare funder, we manage carefully planned funding guidelines to ensure the Scheme is able to cover claims now and into the future. Our role is to ensure members of the Scheme enjoy access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design, the creation and application of funding policies and clinical protocols which are developed using a rigorous, evidence-based decision-making process.
We are not insensitive to your plight in dealing with the situation, but hope that we have gained your understanding why it is unfortunately not possible to provide the outcome you were hoping for. We can however assure you that the Scheme is acting within the rules and regulation on your specific chosen plan type.
Should you wish to take the matter up, you may approach the Council for Medical Schemes for assistance, you may do so in writing to: Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 or via e-mail at ***. Customer Care Centre: ***/website www.medicalschemes.com.
Should you require further details on this matter please contact ***3 alternatively email ***
Regards
Bankmed Servicing Team
Hi Leonard
We’ve confirmed with that our Medical Advisors has reviewed your request and declined funding as the diagnosis supp**** by the treating Doctor was not a Prescribed Minimum Benefit. We recognise that the treating doctor is in the best position to make medical decisions regarding the treatment options available. In reaching this decision we have not questioned the diagnosis or the treatment recommended by the treating doctor.
As a healthcare funder, we manage carefully planned funding guidelines to ensure the Scheme is able to cover claims now and into the future. Our role is to ensure members of the Scheme enjoy access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design, the creation and application of funding policies and clinical protocols which are developed using a rigorous, evidence-based decision-making process.
We are not insensitive to your plight in dealing with the situation, but hope that we have gained your understanding why it is unfortunately not possible to provide the outcome you were hoping for. We can however assure you that the Scheme is acting within the rules and regulation on your specific chosen plan type.
Should you wish to take the matter up, you may approach the Council for Medical Schemes for assistance, you may do so in writing to: Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 or via e-mail at ***. Customer Care Centre: ***/website www.medicalschemes.com.
Should you require further details on this matter please contact ***3 alternatively email ***
Regards
Bankmed Servicing Team
