Urgent Appeal Against Declined Hospital Admission Authorization!!!!!!!!!!!!

To Whom It May Concern,

I am writing to formally express my extreme dissatisfaction and concern regarding the refusal to authorize my hospital admission, despite clear medical recommendations from multiple healthcare professionals and the existence of a potentially serious medical condition requiring further investigation and treatment.

On 14 September 2026, I consulted with Dr B. Sumbulu at Netcare Medicross, who conducted an examination and reviewed my blood test results. Following her assessment, she noted a possible venous thromboembolism (VTE) and documented an acute-on-chronic history of bilateral calf pain. During the examination, tenderness was elicited in both calves, and a D-Dimer test was performed. Based on her clinical findings and concerns, she recommended hospital admission and further management.

I was subsequently referred to Dr R. Issac, Physician, at Life Flora Hospital, and attended the hospital on 15 September 2026 at approximately 11:30 am. Upon arrival, I was assessed in the emergency department by Nurse Edwin, Dr N. Randera, and Dr Palmer.

As part of their investigation, numerous diagnostic tests were conducted, including blood tests, X-rays, and an ultrasound examination of my legs. These investigations included, amongst others:

Full Blood Count (FBC) D-Dimer Testing Renal Function Tests C-Reactive Protein (CRP) HbA1c Thyroid Function Tests (TSH) Vitamin B12 Assessments

Notably, various inflammatory markers and blood parameters were reviewed, including elevated white blood cell counts and neutrophil levels, which warranted further medical attention and correlation with my clinical presentation.

Importantly, the D-Dimer test utilized the VIDAS ELISA method, widely regarded as the gold standard in D-Dimer testing. While this test provides significant diagnostic value, the treating doctors and pathology laboratory clearly indicated that additional definitive investigations are required to properly exclude or diagnose conditions such as deep vein thrombosis (DVT), pulmonary embolism, or other underlying causes of my symptoms. These further investigations can only be appropriately completed within a hospital setting under the guidance of medical specialists.

My concern is therefore straightforward:

How can an admission be declined when the very purpose of admission is to allow medical professionals to conduct the necessary investigations, arrive at a diagnosis, and determine the appropriate course of treatment?

I am struggling to understand the rationale behind a non-clinical authorization process overriding the professional recommendations of multiple qualified medical practitioners who have personally assessed my condition.

For several weeks, I have been suffering from severe and worsening pain in both legs. The pain has significantly impacted my ability to work, sleep, carry out normal daily activities, and even drive safely. The discomfort is debilitating and continues to affect my quality of life.

As a direct result of the declined admission, I was discharged with prescriptions for the following medications:

Targinact SRT 5/2.5 mg (Schedule 6) Trepiline 25 mg (Schedule 5) Lyrica 25 mg (Schedule 5) Xefo Rapid 8 mg (Schedule 3)

Unfortunately, due to the late discharge time, pharmacies were already closed, preventing me from obtaining these prescribed medications. Consequently, I remain without the pain management prescribed by my treating doctors and am expected to endure significant discomfort until I am able to obtain the medication.

I would like to emphasize that patients do not willingly present themselves to emergency departments, undergo countless investigations, or seek hospital admission without valid medical reasons. In this case, my admission has been recommended following clinical examinations, pathology results, and specialist assessments. The delay in authorizing this admission is preventing my treating doctors from completing the investigations required to determine the cause of my symptoms and provide appropriate treatment.

Should my condition deteriorate while awaiting approval for the recommended investigations, I believe it is reasonable to question whether the rejection of my admission contributed to delays in diagnosis and treatment.

I therefore urgently request that this matter be reviewed as a priority and that you engage directly with the treating hospital and physicians to facilitate the admission and investigations they have deemed medically necessary.

I am also requesting:

A detailed explanation for the decision to decline my hospital admission. An urgent review of the authorization decision. Immediate engagement with the treating medical team. Written confirmation of the steps being taken to resolve this matter. A formal response addressing the concerns raised in this complaint.

As a paying member whose healthcare benefits are intended to provide access to medically necessary treatment, I find the current situation both distressing and unacceptable. The emotional and physical strain of having to advocate for medically recommended treatment while suffering significant pain is something no patient should have to endure.

I trust that this matter will receive the urgent attention it deserves and that a satisfactory resolution can be reached without further delay.

I look forward to receiving your response and a clear way forward before close of business tomorrow.

Yours faithfully, Taryll Carol Davis

Bankmed Member Number: [*** - Core Saver Plan] Contact Number: [***] Email Address: [***]

N.B.: Please do not allow experiences such as this to become the reason members choose to leave Bankmed. The quality of service provided to members reflects not only on your organisation but also on the medical aid you represent. While there are many healthcare administrators and insurers available in the market, patients should never be made to feel unsupported, unheard, or obstructed when seeking medically necessary care. Situations such as this significantly undermine confidence in the service being provided and may ultimately influence members to seek alternative healthcare providers who prioritize patient wellbeing and access to treatment.