KR
Kathleen R

1 reviews | Active since Aug 2017

05 Jun 2018, 20:30

Violation of my medical rights

Bankmed...what an excuse for a medical aid. Let me enlighten you about my experience with Bankmed. I am 7 and a half months pregnant and was ready and enthusiastic to give birth in the next seven weeks until today. Bankmed offers a cute programme called baby and me, to make you think they care about you or the baby by giving you a nappy bag once you register for the programme which is covered on your insured benefits (which I pay for monthly). The programme states that they cover the first five gynecologist appointments. However after submitting a claim of my appointments that I paid for cash from December 2017 amounting to R6800.00 they are willing to payout an amount of R 2159.70, Bankmed is only going to pay the above stated amount because my gynecologist is not contracted to Bankmed.I had to contact Bankmed to follow up on my claim to be informed about this. Bankmed did not supply me with a list of doctors and gynecologist whom they are affiliated with when I signed up with Bankmed...They also advised me today on my telephonic calls with them that they are also not going to cover my gynecologist full fees at birth... I will incure a shortfall that I will be liable to pay for my gynecologist, the enthusiast as well as the pediatrician if they are not affiliated with Bankmed. I am on the comprehensive plan which is supposed to be one of the best plans with Bankmed seing that I am paying over R3000 monthly from my salary as the company I am employed at pays the other half close to an estmate of R7000.00 monthly. The comprehensive plan is meant to cover 125%, just to be informed I will still be liable for the shortfall. At 7 and a half months pregnant I am now expected to or shall I rather say "FORCED TO" option 1) fill in a pre-assessment quotation form received from Bankmed today after my call to see how much they are willing to pay for my gynecologist, enthusiast and pediatrician, so that I may make the necessary arrangements to ensure I have the funds available for a comfortable and healthy birth with a gynecologist I have built a relationship with as well as my unborn child...we are all aware that unborn babies register to fami**** voices. Option 2) will be to find a new gynecologist at 7 and a half month pregnant whom is affiliated with Bankmed...oh to my disgust after inquiring there are only 3 gynecologist contacted to Bankmed at the hospital I am registered at and they are all male gynecologist...I mean no disrespect or ************** against these gynecologist, I felt that I would rather be more comfortable with a female gynecologist the second time around, I do have the right to make that decision...but yet again Bankmed is controlling my choices by telling me that they only affiliated with those gynecologist so if you want us to pay these are the only gynecologist we cover at a 100%. I gave birth to my son in 2014 at the same hospital, and did not incur any shortfall with Bankmed on the same plan, I had a planed cesarean section and had my sons circumcised at 3 days and the gynecologist, enthusiast, pediatrician and circumcision was covered. Since Bankmed has moved over to Discovery or affiliated themselves with Discovery, my choices are being controlled with regards to my health which I feel is a violation of my medical rights. My son is registered for chronic medication for his asthmatic condition of which he receives about R20000.00 yearly for chronic medication and receives a asthma pump every 3 months and recently his pediatrician put him on Deselex syrup which he needs to take daily and lasts a month to control his nose and allergies so that it does not have a major impact on his chest and it has been working like a charm. These medications keep my sons allergies and chest controlled. He has a history of being hospitalized for his chest as from six months after birth do they know how stressful it is? No they dont!!!! Yes I feel they are inconsiderate and has No remorse for their client's. Deselex is about close to R400.00 and with it being under chronic which they made me get my pediatrician to put it on chronic self, Bankmed does not cover the full amount that pharmacies charge for the Deselex, bearing in mind I am on the comprehensive plan I still incur a shortfall as Bankmed is only willing to pay about R130.00 for the Deselex which is not even the price the pharmacies pay for a bottle so they loose out. I do not want to have to compromise when it comes to my child's health so I pay the shortfall for my child's medication. He does not even use half of what is allocated to him (what I pay for) but because there is a generic of Deselex at R130.00 I am either to take the generic or pay the shortfall. Yet again decision are being made for me by Bankmed and Discovery as if they are doing me a favour...last time I checked I do pay my monthly contribution to be treated this way as if I am receiving it for free. Whilst on the phone with two different consultants they both showed no remorse and told me this is the benefits Bankmed has to offer.

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Replies (1)
KR
Kathleen R's update05 Jun 2018, 21:15
Reviewer Update
Just to add on to the above, after talking to the bankmed consultants I called the three gynecologist that Bankmed is affiliated with to find out what their consultation fees were as they said my gynecologist charges above the scheme rate. My current gynecologist charges me R1200.00 per consultant and their affiliated gynecologist charge R1500.00 per consultant and they do not want to pay out my full claim of R6800.00 of which if i were with one of their contracted gynecologist they would have needed to pay me R7500.00. This makes no sense...would they have paid out the money or also made excuses. They need to advise as to why do I pay medical aid monthly to be restricted because they looking at where they can save money? This is financially ******ing individuals. I am being totally stressed out and inconvenienced by Bankmed....this is the one thing that I should be having peace of mind with like funeral cover, but with Bankmed there is no surety and security. If I or any of my dependents were to undergo an emergency surgery would I first have to find a surgeon or doctor who is affiliated/contracted to Bankmed to ensure we are covered???? So how important is the health or well-being of their clients to Bankmed/Discovery?