Disappointing service by Claims department

I am rather disappointed with the service I have recently experienced with Bankmed. I had added a new dependent onto my profile in April. I must say getting new business runs very smoothly.

However, when it then comes to claims, that is a whole other story. My new dependent does have a general waiting, which I very much understand exactly what that entails based on a few discussions I have had with various different people within Bankmed.

I had pre-existing chronic conditions that was loaded for my new dependent, from her previous medical aid. Again, this process was seamless, kudos to the chronic team in this regard. When I contacted the new business team to enquire on exactly what the General 3 month waiting period entailed, they said if my dependent had to visit the doctor for any of their pre-existing chronic conditions, this will be covered, based on the scheme rate. Also, if my dependent had to get admitted into hospital for one of their pre-existing conditions, again, it will be covered.

I had this exact scenario (unfortunately) and my dependent's chronic medication was covered fine last month, and the recent admission into hospital was fine as well.

However, now when I am trying to understand from the Claims department why they have rejected completely a recent claim done to the specialist for a visit relating to a "PRE-EXISTING CHRONIC CONDITION" that has been loaded, I get the below different responses from the exact same person I was chatting to: 1) Because it is a general day to day visit, it would not be covered during this 3 month waiting period. My response: But this is not a day to day visit, it relates to their pre-existing chronic condition. I get silence. 2) The claims department say that because the dependent is not on the diabetes care program, they cannot claim. My response: This was for a visit to a Neurologist, why would she go to a Neurologist for diabetes care? I get silence from the person I am chatting to. And then he goes back to excuse point #1. 3) There are no chronic conditions loaded against the profile of your dependent. My response: This is utter nonsenses, because the chronic department confirmed with me via email that all the conditions were loaded, and how is it that the hospital visit and chronic meds were covered during the general waiting period if there is nothing loaded? I get silence, proceeded again by default excuse point #1.

I am very frustrated at this point and I asked to speak to a supervisor and was waiting on hold for around 5-10mins with no one answering my call. I then cancelled the call.

By the way, I also called on a previous occasion to confirm about the visit to a doctor/specialist relating to a pre-existing condition and again that person I chatted was also saying that there is no chronic conditions loaded. But when he actually listened to what I had to say and then made the effort to contact the chronic department, guess what he found out???? There are actually chronic conditions loaded and he then also confirmed with me that yes, a visit to the doctor/specialist relating to the pre-existing condition should then be covered up to the scheme rate.

I don't understand why I have to continuously go through this over and over again whenever I call into the claims department. It is very frustrating and clearly there is some break in between the chronic area and what they load vs what the claims people see. I would like to please be contacted by someone that knows exactly the rules and is able to assist me properly.