RV
Rowan V
1 reviews | Active since Jul 2010
09 Feb 2016, 10:44
Not Covering full benefit for Contact Lenses
Good Day, please note that I ordered contact lenses from PG Optics in Alberton, however, was advised that there was a co-payment even though the claim was below the yearly cover of R1395.00 pb/pa. As per Bankmed's reply, this co-payment was as a result of not using a PPN provider. However, the cover states: \a Preferred Provider Network (PPN) optometrist or any other optometrist\". So whether it is a PPN provider of any other optometrist, the claim should be paid in full. Please could I understand why Bankmed/PPN is not covering the full amount for the contact lenses. Regards."
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Bankmed's replyOfficial
10 Feb 2016, 17:40Hello Rowz,
Thank you for your comment.
On your chosen plan type contact lenses are covered at 100% of cost (The net cost (after discount) charged for a relevant health service or, in respect of a contracted or negotiated service, the contracted rate. In the case where a non-network provider is used, cost will imply the Scheme Rate). Should the provider charge above the Scheme Rate, the shortfalls will be for your own pocket regardless of whether it falls within the limit for this benefit.
You are more than welcome to contact the PPN department on *** to find providers that are contracted in to avoid any shortfalls. They will also be able to confirm the finer details surrounding the benefit.
Regards
Annelize
Bankmed Servicing
Thank you for your comment.
On your chosen plan type contact lenses are covered at 100% of cost (The net cost (after discount) charged for a relevant health service or, in respect of a contracted or negotiated service, the contracted rate. In the case where a non-network provider is used, cost will imply the Scheme Rate). Should the provider charge above the Scheme Rate, the shortfalls will be for your own pocket regardless of whether it falls within the limit for this benefit.
You are more than welcome to contact the PPN department on *** to find providers that are contracted in to avoid any shortfalls. They will also be able to confirm the finer details surrounding the benefit.
Regards
Annelize
Bankmed Servicing
Bankmed's reply10 Feb 2016, 17:40
Official
Hello Rowz,
Thank you for your comment.
On your chosen plan type contact lenses are covered at 100% of cost (The net cost (after discount) charged for a relevant health service or, in respect of a contracted or negotiated service, the contracted rate. In the case where a non-network provider is used, cost will imply the Scheme Rate). Should the provider charge above the Scheme Rate, the shortfalls will be for your own pocket regardless of whether it falls within the limit for this benefit.
You are more than welcome to contact the PPN department on *** to find providers that are contracted in to avoid any shortfalls. They will also be able to confirm the finer details surrounding the benefit.
Regards
Annelize
Bankmed Servicing
Thank you for your comment.
On your chosen plan type contact lenses are covered at 100% of cost (The net cost (after discount) charged for a relevant health service or, in respect of a contracted or negotiated service, the contracted rate. In the case where a non-network provider is used, cost will imply the Scheme Rate). Should the provider charge above the Scheme Rate, the shortfalls will be for your own pocket regardless of whether it falls within the limit for this benefit.
You are more than welcome to contact the PPN department on *** to find providers that are contracted in to avoid any shortfalls. They will also be able to confirm the finer details surrounding the benefit.
Regards
Annelize
Bankmed Servicing