Nothing but excuses for not paying out claims in full

<p>I obtained full authorisation from Bankmed to get my gallbladder removed on the 3rd of May, the specialist surgeon that was to perform the operation was contracted to Bankmed <br />so he and the hospital were paid. This morning I now get a call from the anaesthetist of being short paid and now I am liable for a co-payment for a procedure that i received <br />authorisation for and that is also a PMB. I called Bankmed this morning to find out why they short paid the doctor as I have never had any problems with anaesthetist that are not contracted <br />to the scheme being short paid, particularly for a PMB condition. I'd understand if I had voluntarily gone to a different doctor and chose not to go to one that contracted to Bankmed <br />but this is not the case, what makes this even worst is that anaesthetists are not doctors you consult with, you only meet them when you are in theatre, the day before I went into theatre <br />i went to the bankmed site to see find one that is a DSP and found that there were none and I didnt think that I would have have the problem that I am facing now <br />as there are no anaesthesiologist that are contracted to Bankmed at that hospital or in my area, so where was I supposed to source one ? and why am I now being held liable for a co-payment <br />instead of Bankmed just paying him in full ? I brought this up when i was speaking to the Bankmed consultant and she told me for Bankmed to do this the doctor should motivate why they are the one who picked up my case <br />and only then will it be reviewed which I think is complete nonsense!!!!!</p> <p>Why should the doctor motivate that you have no Anaesthetist at that hospital. Is it not correct to assume that before you process a claim and decide to short pay it to your scheme rate it should be <br />within good reasons instead of taking chances then have your clients complaining and following up on you ? If you do not have DSP's within close proximity you are meant to pay that particular claim in full <br />as you always have in the past, why is this now an issue ? in fact i read this on your clauses that if I am deemed to have involuntarily obtained a service from that healthcare provider as there was no <br />DSP within reasonable proximity and you should therefore pay him in full. Instead you are nitpicking and trying to find all reason to NOT pay this claim in full which I find to be quite disappointing and <br />********* and it should be sorted out.</p>