1 reviews | Active since Feb 2016
*********** and Ridicules service
I'm disappointed in the *********** and Ridicules service received from bankmed, did not had this before when they were with metropolitan. I had to see a Maxilo facial & oral surgeon, Bankmed could not supply me with one, due to no one listed on their system for my area. Melissa said not even for Krugersdorp and that I have to find a surgeon on my own. I'm on a savings plan with benefits, so they took all costs from my savings but suppose to pay from my benefits, due to my surgeon Dr. Lawrence is not listed. When I phoned them they said my surgeon's fees exceeds max payable from the scheme, how is this possible? I never had this with metropolitan. Then last week Lauren from bankmed said last week to me that there is a surgeon listed on their system in Krugersdorp... It's now to late why couldn't you tell me this last month before I went to the surgeon at wilgerheuwel, because your services are ridicules. I want Bankmed to fix this due to they couldn't provide me with a listed surgeon in January 2016.
Thank you for your comment.
We investigated your query and below is a brief overview:
On your chosen plan type the Scheme confirms that cover for Maxillofacial and oral surgery: Consultations, procedures and treatment in and out of hospital is limited to PMBs. You are covered up to 100% of cost, subject to available savings for non-PMBs. The fact that you had chosen a non-dsp had no bearing on the funding decision of the claim. The ICD-10 code on the claim determines whether the claim is funded from your available savings or from PMB. The ICD-10 code noted on both the claims does not form part of the 270+ PMB conditions listed as per the Council for Medical Schemes. The claims have been funded correctly as per your plan type and Scheme rules.
We have sent you an email with further information on your query. I am sorry that I could not provide you with a different outcome to your query.
Regards
Jashvir
Bankmed Servicing
Thank you for your comment.
We investigated your query and below is a brief overview:
On your chosen plan type the Scheme confirms that cover for Maxillofacial and oral surgery: Consultations, procedures and treatment in and out of hospital is limited to PMBs. You are covered up to 100% of cost, subject to available savings for non-PMBs. The fact that you had chosen a non-dsp had no bearing on the funding decision of the claim. The ICD-10 code on the claim determines whether the claim is funded from your available savings or from PMB. The ICD-10 code noted on both the claims does not form part of the 270+ PMB conditions listed as per the Council for Medical Schemes. The claims have been funded correctly as per your plan type and Scheme rules.
We have sent you an email with further information on your query. I am sorry that I could not provide you with a different outcome to your query.
Regards
Jashvir
Bankmed Servicing