Worst Medical Aid - Bankmed

I am writing today to express my dissatisfaction with the way my daughter’s procedure request has been handled to date.

She has been suffering from pain and inflammation caused by her wisdom teeth over the last month. Upon consultation with the dentist, it was established that she needs to have her 4 wisdom teeth removed as they cannot come out due to being blocked by the neighbouring teeth.

I have contacted Bankmed on numerous occasions to understand why this has not been approved citing that it is outside of PMB benefits. The first feedback was that it was due to the ICD codes being maxilla facial codes and that these need to be changed. After numerous instances of back and forth, I am advised that there are not other codes used to remove the wisdom teeth. I am now being told that this plan does not cover anything in hospital. After enquiry at the dental rooms I find that this procedure cannot be done in the dental rooms and must be done in theatre.

I had rude engagement with Puseletso Mhlakaza from Bankmed's pre-auth dept telling me that the motivations sent with the same icd codes are still going to be declined, even though I am yet to get a response from Bankmeds MRT team. I am paying R8K a month to Bankmed who cannot cover the removal of my daughters wisdom teeth. Everytime I call bankmed they claim to have not received my correspondence and request for something else.

My daughter is in pain and cannot eat. Please explain to me what I am supposed to do in this situation where the doctor has also submitted a motivation for this procedure with no response to date?