Refusal to cover a necessary procedure

<p>I sent through a pre-assessment to Bankmed and the feedback i received is that my Dr's are charging in total an estimate of R22800.00 and Bankmed is only willing to pay R6854 leaving me with an amount of about R16000 which I "will have to pay for". i called in now, spoke to the courteous Siyanda in escalations who referred my call to the very unhelpful, very patronising Mattew. Matthew asked me why i feel my case is "special" and why not go to a cheaper Dr. When i told him that i'm paying for a service and now i need to use that service he told me that's the problem...that i "expect" payment. Ofcourse i expect payment, isn't that what i'm paying for every month? For six years i've been with Bankmed, this is the first major procedure i need to have done. And i get told by a consultant that taking this further is "a waste" of my time.</p> <p> </p> <p>I told Matthew that for years i've been paying out of pocket with Dr's visits and much needed medication. At some point i paid R1500 for a specialist visit and Bankmed paid me back less than R280. For a referral from a specialist to another specialist. I kept quiet. Every 3 months i have to see this specialist and i pay R900, twice i have not claimed, once i claimed and was paid back R350 and some odd change. My GP is paid R450 for a visit but for a specailist Bankmed sees fit to pay R350???? My son also has to see his Paedy every 3 months, i pay R800 and never get back anything more than R400. I pay a levy close to R300 a month for my son's chronic medication every single month!</p> <p> </p> <p>It's cost on top of cost on top of cost for a medical aid plan that's supposed to cover EVERYTHING! I've let it all go. All of it. But now i need to have an operation, and you're telling me you'll only cover less than 30% of the cost. LESS THAN THIRTY PERCENT!!! How is this service? How is this acceptable??? Someone needs to look into this urgently as this is ****************.</p>