Unprofessional and Disrespectful Treatment from Consultant

On Monday, 18 August 2025, I contacted Client Services regarding a PMB claim that had not been funded correctly. I spoke with a consultant named Simpiwe. Initially, he was friendly and seemed eager to assist, but his attitude quickly changed during the call.

He first informed me that the ICD-10 code I referenced (L03.3) is not a PMB condition. Despite my explanation that it is, he repeatedly argued, insisting that his “helper tool” showed otherwise. I then pointed out that claims from December 2024 with the exact same ICD-10 code had been funded from PMB. He dismissed this, saying those claims were processed incorrectly and that he would need to investigate them.

I further explained that I have claims dating back as far as 2021, all with the same ICD-10 code, and all funded as PMB. In my profession, I work with medical billing and ICD-10 codes daily, so I am confident in this information. Only after I clarified that my PMB reference list shows all L03 codes (L03.1 to L03.8) are PMB conditions did he admit that he had initially looked up the wrong code.

Instead of resolving the matter, he then shifted to discussing Bankmed’s billing practices. Each time I tried to explain that I had encountered and resolved similar issues with Bankmed before, he became increasingly agitated—as did I. At one point, he even told me to “keep quiet” so that he could finish speaking, which I found extremely unprofessional.

I acknowledge that I was frustrated during the call, but I do not believe that a consultant should ever speak to a member in such a dismissive and disrespectful way. In all my 23 years as a Bankmed member ****il May this year), I have never experienced a consultant addressing me in this manner. It was both upsetting and disappointing to be treated this way after such long-standing membership.