Decline funding and change reason 3 times!! inconsistent!!

Most useless medical aid. Ever since Bankmed has started being administered by Disovery- the customer service as well as their funding as become appalling.

I currently am undergoing my second round of orthodontics treatment because I have a misaligned bottom jaw. The issue cannot be corrected with orthodontics alone, I require orthognatic surgery on the bottom jaw to correct this misalignment. I submitted the maxillo facial surgeons quote to Bankmed in March- as this procedure requires pre authorization. I have the comprehensive plan-which is one of the top plans. Bankmed rep**** to this quote with the scheme rates they will cover per ICD 10 code. There is a shortfall but we were okay to pay it as the surgeon is slightly above scheme rates.

Thereafter Bankmed reverted back with questions pertaining to the necessity of the surgery- the surgeon had to provide motivations as to why the surgery was necessary in order for Bankmed to authorize. My orthodontist as well as my surgeon (A PROFESSOR) provides relevant motivations to Bankmed. Bankmed declined funding as they stated there is no functional impairment. My surgeon was surprised by this because Bankmed usually don’t have issues with funding these surgeries and he explained to us that with orthognatic surgery there rarely is a functional impairment, rather there will be a functional impairment in future if the patient does not undergo surgery to adjust the bite.

We appealed to Bankmeds declination. They then told us another (different reason) for declining: the procedure does not fall under my Prescribed minimum benefits (PMBs). I was confused because I thought the procedure did fall under my PMBs because they initially informed us how how much the scheme was willing to pay per ICD10 code...

Bankmed were unhelpful in finding a solution and simply told me to approach the counsel for medical schemes- which seemed to be very dismissive.

We did this. Bankmed have changed their reason for declining funding 3 TIMES!!! They are inconsistent. I phoned Bankmed today because I was looking into funding the surgery myself but realized it’s not possible because I would have to cover the surgery as well as the hospital bill which is waaay more than I anticipated. The consultant at Bankmed finally informed me that the ICD10 code is the issue - first time I’m hearing this. This case has been going on since MARCH and not a single Bankmed consultant could inform me that the ICD 10 code does not allow the procedure to fall under my PMBs.

I phoned the surgeon after this and they informed me that Bankmed should not be dealing with the claim under PMBs- hence why the ICD10 code is not valid. Bankmed should be dealing with the claim as per my advanced dentistry limits- that I qualify for, where this surgery is an advanced dentistry procedure.

Not once has Bankmed explained anything properly Not once has Bankmed given me a phone call with guidance on this claim Not once has Bankmed given proper clarification of as to why the funding has been denied

Overall USELESS. The frustrating part is that Bankmed have literally told me: “this is what we cover per ICD10 code for this procedure”.....”but we don’t approve funding”. There is also uncer*****y as to what medical professionals within Bankmed are reviewing cases- are they even on par with the Doctors that diagnose and treat patients?

?????? I don’t understand this incompetency. I qualify for surgery- as Bankmed have stipulates amounts they pay but just won’t pay?? We pay R12 000 a month for this medical aid- Bankmed still don’t cover the entire portion of Drs Bills, they straight up deny funding for surgery that, WE WOULD PROBABLY BE ABLE TO AFFORD HAD WE JUST SAVED THAT R12 000 INTO A SAVINGS ACCOUNT. What a ****.

Bankmed is a ****. I will not stop complaining- I will continue to submit quotes and complaints and I will approach the ombudsman. No enterprise should be able to get away with ******** people in broad daylight like Bankmed does. Bankmed does not operate with their members interests in mind. It is evident