No feedback and still given a run around on outstanding hospital claim

After a long wait and several follow ups, I received a call today from Bankmed telling me that the claim has been rejected by the clinical team because my condition was not a "life threatening" and it did not meet the prescribed minimum benefits. Bankmed only paid the casualty doctors for a normal GP consultation leaving me with a huge shortfall and when I enquired I was asked to submit a casualty report which shows that i was admitted in hospital and they will fund the claim from hospitalization. I submitted the report and after 2 weeks of no reply when I followed up I was then asked for a report from radiology. When I submitted the report I was told that feedback will be provided within 48 hours from the review team. Today I had to follow up seeing that the days provided elapsed and that is when I received a call to say the claim is rejected. Bankmed paid all other claims fully including authorizing for me to go for operation but now I am told my condition was not life threatening. Further to the radiology report there were pathology tests that were done where the abnormalities were picked up but Bankmed chooses to dismiss. This is ridiculous and if my employer had another option for medical aid I was going to move because with Bankmed you must be dying in order for your claims to be funded in full.

Please note that the issue is not that you were unable to provide a favorable outcome, but the issue is that your feedback is unsatisfactory and incomplete.
I have not received feedback from you in writing regarding the reason for rejection of the claim with possible reference from your benefits schedule for me to understand.

You gave me feedback telephonically and I requested to receive feedback to be in writing with clear explanation on the reason for rejection but I still await same.
You called me at 11:15 and advised that you will email me the forms to complete if I consider to appeal but up to now I have not received same.

According to your BENEFIT & CONTRIBUTION SCHEDULE 2026, BENEFIT TABLES 2026:
9.1. Casualty and outpatient consultations states ,"Regarded as an out-of-hospital GP/specialist consultation in rooms, unless resulting in an authorized hospital admission.
9.2 Facility fees, states "Facility fees subject to ‘Specialist Consultations In-room or Out-of-hospital’ benefit, unless resulting in an authorised hospital admission".
33.1 GP consultations In-hospital states " • Unlimited
• 100% of cost at DSP
• 100% of Scheme Rate for non-DSP
• DSP: Bankmed GP Network

In line with the above, please provide me with feedback in writing as requested telephonically ,followed by clear explanation and possible reference from your benefits schedule that shows that the claim not funded in full did not meet your PMB.