TG
Thandekile G
1 reviews | Active since Oct 2025
30 Oct 2025, 11:39
Claim not process
I am writing to formally escalate my medical claim submitted on 26 August 2025 for reimbur*****t. The claim was initially rejected due to a missing ICD-10 code, which was subsequently provided along with a resubmitted claim. Thereafter, I was informed that the invoices were incorrect. I then supp**** a new set of valid tax invoices, which also included the ICD-10 code. Despite this, I received another communication from the service provider indicating that the medical aid is once again requesting the ICD-10 code — even though it has already been submitted multiple times and appears clearly on the invoices.
Each time the claim is rejected, I am required to resubmit all documents and wait again for processing. This has now occurred several times, with no progress or resolution. It has been over two months since the initial submission (26 August 2025), yet the claim remains unresolved. According to your stated process, claim finalization should take approximately 4 to 5 working days.
This experience has been extremely disappointing and suggests unnecessary delays that appear to be preventing the claim from being finalized. I request that this matter be urgently escalated and resolved without any further delay.
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Replies (4)0
Replies (4)
Bankmed's replyOfficial
30 Oct 2025, 15:12Hi Thandekile, Thank you for raising this. I am sorry for the ongoing frustration and delays you have experienced. This is not the standard of service we aim to provide, and I completely understand your concern given the time and effort you have already invested. We will look into the matter in its entirety and ensure it is escalated for urgent resolution. You deserve clarity and closure, and we will do everything we can to help make that happen.
Best regards,
Bankmed's reply30 Oct 2025, 15:12
Official
Hi Thandekile, Thank you for raising this. I am sorry for the ongoing frustration and delays you have experienced. This is not the standard of service we aim to provide, and I completely understand your concern given the time and effort you have already invested. We will look into the matter in its entirety and ensure it is escalated for urgent resolution. You deserve clarity and closure, and we will do everything we can to help make that happen.
Best regards,
TG
Thandekile G's updateReviewer Update
03 Nov 2025, 19:23 I am deeply disappointed to be writing yet again regarding my unresolved medical claim, originally submitted on 26 August 2025 for reimbur*****t. Following my previous complaint on HelloPeter, I received a response from Bankmed on 30 October 2025, assuring me that the matter would be urgently investigated and escalated for resolution. Unfortunately, since that response, absolutely nothing has been done — no feedback, no update, and no indication of progress. It has now been over two months since the claim was first submitted, and I am still waiting for a simple reimbur*****t that should, according to your own timelines, take 4–5 working days. The repeated requests for the same ICD-10 code — which has been submitted multiple times and appears clearly on the invoices — show a concerning lack of coordination and accountability. The lack of feedback after your 30 October commitment to "urgent escalation" only adds to the frustration. This is unacceptable customer service from a medical aid provider, and I feel completely disregarded as a member. I am now requesting that this complaint be escalated to senior management and that I receive a written update with a confirmed resolution date. This ongoing delay is unfair and unprofessional. Unhappy and disappointed customer.
TG
Thandekile G's update03 Nov 2025, 19:23
Reviewer Update
I am deeply disappointed to be writing yet again regarding my unresolved medical claim, originally submitted on 26 August 2025 for reimbur*****t. Following my previous complaint on HelloPeter, I received a response from Bankmed on 30 October 2025, assuring me that the matter would be urgently investigated and escalated for resolution. Unfortunately, since that response, absolutely nothing has been done — no feedback, no update, and no indication of progress. It has now been over two months since the claim was first submitted, and I am still waiting for a simple reimbur*****t that should, according to your own timelines, take 4–5 working days. The repeated requests for the same ICD-10 code — which has been submitted multiple times and appears clearly on the invoices — show a concerning lack of coordination and accountability. The lack of feedback after your 30 October commitment to "urgent escalation" only adds to the frustration. This is unacceptable customer service from a medical aid provider, and I feel completely disregarded as a member. I am now requesting that this complaint be escalated to senior management and that I receive a written update with a confirmed resolution date. This ongoing delay is unfair and unprofessional. Unhappy and disappointed customer.
Bankmed's replyOfficial
04 Nov 2025, 12:50Hi Thandekile, The Executive Office has been made aware of this matter, and we sincerely apologise for the lack of communication from 30 October until your recent follow-up. While it may have appeared that no progress was being made, background work has been underway. We are pushing to have this matter finalised before the end of the week. The issue with the claims lies in the format of the invoices submitted by the provider. Although the correct ICD-10 codes are reflected, they are not structured at line-item level, which is a requirement for claims processing. As per the South African ICD-10 Coding Standards, all claims must include ICD-10 codes at line-item level to ensure accurate processing and benefit allocation. This requirement is outlined under GSN0101: Mandatory Inclusion of ICD-10 Codes on Claims and GSN0103: Paper and Electronic Claims containing ICD-10 Codes. We understand the distress this has caused and want to alleviate that burden. We will liaise directly with the provider to resolve the formatting issue and will keep you updated as we receive further information. You don’t have to do anything.
Best regards,
Bankmed's reply04 Nov 2025, 12:50
Official
Hi Thandekile, The Executive Office has been made aware of this matter, and we sincerely apologise for the lack of communication from 30 October until your recent follow-up. While it may have appeared that no progress was being made, background work has been underway. We are pushing to have this matter finalised before the end of the week. The issue with the claims lies in the format of the invoices submitted by the provider. Although the correct ICD-10 codes are reflected, they are not structured at line-item level, which is a requirement for claims processing. As per the South African ICD-10 Coding Standards, all claims must include ICD-10 codes at line-item level to ensure accurate processing and benefit allocation. This requirement is outlined under GSN0101: Mandatory Inclusion of ICD-10 Codes on Claims and GSN0103: Paper and Electronic Claims containing ICD-10 Codes. We understand the distress this has caused and want to alleviate that burden. We will liaise directly with the provider to resolve the formatting issue and will keep you updated as we receive further information. You don’t have to do anything.
Best regards,
Bankmed's replyOfficial
04 Nov 2025, 15:00Hi Thandekile, We attempted to reach the accounts department at the practice and managed to get through to Adele. She is currently unavailable, but we will follow up again at the earliest opportunity.
Best regards,
Bankmed's reply04 Nov 2025, 15:00
Official
Hi Thandekile, We attempted to reach the accounts department at the practice and managed to get through to Adele. She is currently unavailable, but we will follow up again at the earliest opportunity.
Best regards,