Formal Complaint Regarding Preventative Childhood Dental Benefit Claim

Dear Sir/Madam,

I hope this email finds you well.

I am writing to lodge a formal complaint regarding the processing of a dental claim submitted in August 2026 for my child, Okuhle Sinqaba.

In January 2026, Okuhle underwent a dental consultation under the Preventative Childhood Dental Check-Up Benefit, and the claim was correctly paid from the medical scheme benefit. According to the rules of this benefit, eligible child dependants qualify for two preventative childhood dental check-ups per year.

When the same preventative procedure was performed on 29 August 2026, I was surprised to discover that the claim was paid from my Medical Savings Account (MSA) instead of the Scheme benefit.

To clarify the matter, I contacted Bankmed on 24 August 2026 and spoke with Chandre, who confirmed that Okuhle qualifies for this benefit. I followed up again on 3 September 2026 and spoke with Mihlali, who advised that the matter would be investigated and that feedback would be provided by 8 September 2026. Unfortunately, no feedback or resolution was provided.

Thereafter, I contacted the service centre and spoke with Nathaniel Grootboom. Regrettably, I found the interaction unsatisfactory, as he appeared unwilling to assist and advised that the matter would not be resolved despite my concerns. Meaningful assistance was only provided after I requested the complaints email address.

On 12 September 2026, I received confirmation that the claim had been processed incorrectly. Given that the error has been acknowledged as an internal processing error, I firmly believe that I should not be financially prejudiced as a result. The claim should have been paid from the applicable Scheme benefit, as was the January 2026 claim, and not from my Medical Savings Account.

For ease of reference:

January 2026 claim: Preventative childhood dental check-up correctly paid from the medical scheme benefit. August 2026 claim: Same preventative benefit incorrectly paid from the Medical Savings Account (Reason Code 547: "We have paid the claim from your Medical Savings"). 12 September 2026: Confirmation received that the claim had been paid incorrectly.

I therefore formally request that:

The August 2026 dental claim be reviewed and reprocessed under the Preventative Childhood Dental Check-Up Benefit. The amount incorrectly deducted from my Medical Savings Account be reimbursed in full. Written confirmation be provided once the correction has been completed.

I trust that Bankmed will rectify this matter promptly, as members should not be disadvantaged financially due to internal processing errors. I would appreciate urgent attention to this complaint and a written response outlining the corrective action taken.

I look forward to your prompt resolution of this matter.

January claim

Claim detail Date of healthcare service Healthcare professional Practice type Amount claimed 2026-01-10 Dr D I Maringa Inc Dentist R 2,934.60 Payment details Amount paid Not paid Payment to Payment from Payment date R 1,908.00 R 1,993.40 Service provider The medical scheme 2026-01-15 (R 966.80) R 1,993.40 Service provider The medical scheme Amounts in brackets indicate a negative amount. View the original claims notification Breakdown of information for each part of the claim Date of healthcare service Patient name Amount claimed Scheme Reimbur*****t Rate Not paid Amount paid To you Healthcare professional Reason for short- or non-payment 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 59.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 966.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 966.80 R 966.80 R 0.00 R 0.00 321 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 0.00 R 0.00 R 59.80 2026-01-10 Okuhle Sinqaba R 204.10 R 212.20 R 0.00 R 0.00 R 204.10 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 0.00 R 0.00 R 966.80 2026-01-10 Okuhle Sinqaba (R 966.80) (R 1,005.40) R 0.00 R 0.00 (R 966.80) 36 2026-01-10 Okuhle Sinqaba (R 59.80) (R 62.00) R 0.00 R 0.00 (R 59.80) 36 2026-01-10 Okuhle Sinqaba R 121.60 R 126.40 R 0.00 R 0.00 R 121.60 2026-01-10 Okuhle Sinqaba R 177.50 R 184.60 R 0.00 R 0.00 R 177.50 2026-01-10 Okuhle Sinqaba R 311.10 R 323.50 R 0.00 R 0.00 R 311.10 2026-01-10 Okuhle Sinqaba R 59.80 R 59.80 R 0.00 R 0.00 R 59.80 321 2026-01-10 Okuhle Sinqaba R 67.10 R 69.80 R 0.00 R 0.00 R 67.10 Reason for short- or non-payment 320 We did not pay this claim line under the standard process. We reprocessed it as an exception. Please see the last claim line or the claim line with reason code 321 to see how we paid it. 321 We paid this amount as an exception. It is linked to a previous line that we processed differently (see reason code 320). 36 This is an adjustment of a claim that we have processed before.