Scores reflect the Overall AI Score for each category
Based on recent customer reviews, Bankmed is described by members as a scheme where administrative failures overshadow occasional excellent service. Customers consistently report authorised claims left unpaid, declined chronic medication and unanswered follow ups, with Claims Processing & Authorisation (0.6) and Billing, Payments & Account Management (0.6) drawing the sharpest criticism. A recurring theme is that individually named consultants deliver outstanding help, lifting Customer Service & Staff Quality (1.2) slightly above the rest.
Top Strengths:
- •Customer Service & Staff Quality: The strongest theme, carried almost entirely by individual consultants. Members name Luvuyo, Chanay, Riaaz Khan, Lebogang Sijila and Lizo as knowledgeable, patient and willing to go beyond their brief, and long standing members recall consistently professional call centre treatment.
Replied to 100% of negative reviews
Reply time on negative reviews: 3h 59m
TrustIndex
3.5
Ranking
#7
in Medical Aid
Reply Time
4h 41m
NPS Score
-86
Recommended: Unlikely
Replied to 100% of negative reviews
Reply time on negative reviews: 3h 59m
Oct '25 - Sep '26
Frequently Asked Questions About Bankmed
What do customers say about Bankmed?
Based on recent customer reviews, Bankmed is described by members as a scheme where administrative failures overshadow occasional excellent service. Customers consistently report authorised claims left unpaid, declined chronic medication and unanswered follow ups, with Claims Processing & Authorisation (0.6) and Billing, Payments & Account Management (0.6) drawing the sharpest criticism. A recurring theme is that individually named consultants deliver outstanding help, lifting Customer Service & Staff Quality (1.2) slightly above the rest.
What is Bankmed's biggest strength?
Bankmed's biggest strength, according to Hellopeter's AI analysis, is Customer Service & Staff Quality. The strongest theme, carried almost entirely by individual consultants. Members name Luvuyo, Chanay, Riaaz Khan, Lebogang Sijila and Lizo as knowledgeable, patient and willing to go beyond their brief, and long standing members recall consistently professional call centre treatment.
What are the most common complaints about Bankmed?
The most common complaint about Bankmed, based on Hellopeter's AI analysis of recent customer reviews, is Communication & Responsiveness. Members describe emails to claims, escalations and even executive addresses going unanswered for weeks. Promised callbacks from agents, team leaders and client relationship managers repeatedly fail, and one member was told a required document existed only as an internal system note.
How does Bankmed compare to other Medical Aid companies?
Bankmed scores 1.1 out of 5 on Hellopeter's AI analysis of service quality in Medical Aid, compared to the Medical Aid industry average of 1.8. Their strongest theme is Customer Service (1.3); their weakest is Claims Processing (0.9). The top AI-rated Medical Aid business on Hellopeter is AGS Health (4.1). How is the AI Score calculated? →
Is Bankmed trustworthy?
Bankmed has a TrustIndex of 3.5 out of 10 on Hellopeter, based on 91 reviews in the last 12 months. They reply to 100% of negative reviews, typically within 3 hours 59 min. Hellopeter has tracked Bankmed across 1,559 total reviews. How is the TrustIndex calculated? →
Recent reviews (91)
Used this business recently? Share your experience to help others decide.
Used this business recently? Share your experience to help others decide.
Share Your Experience1 reviews | Active since Jul 2013
Bankmed's delay in providing medical records is holding up my cancer-related insurance claims
I am extremely disappointed with Bankmed's failure to provide medical aid records requested by Momentum, despite my follow-ups since the beginning of September. Momentum has confirmed that it is waiting for my Bankmed medical aid records for March 2019 to March 2024. Their request reference numbers are *** and ***. This is not a routine administrative matter. The outstanding records are preventing Momentum from completing its Early Claims Process and finalising my critical illness, disability and income protection claims relating to my cancer diagnosis. I have been waiting for feedback from Bankmed since the beginning of September, yet the matter remains unresolved. The continued delay is causing unnecessary additional stress at an already extremely difficult time. I urgently request that Bankmed: Escalate this matter immediately. Send the outstanding records to Momentum without further delay. Confirm in writing when the records have been sent. Provide an explanation for the delay and a complaint/escalation reference number. Bankmed, please treat this with the urgency and sensitivity that a cancer-related claim deserves.
1 reviews | Active since Jul 2013
Bankmed's delay in providing medical records is holding up my cancer-related insurance claims
I am extremely disappointed with Bankmed's failure to provide medical aid records requested by Momentum, despite my follow-ups since the beginning of September. Momentum has confirmed that it is waiting for my Bankmed medical aid records for March 2019 to March 2024. Their request reference numbers are *** and ***. This is not a routine administrative matter. The outstanding records are preventing Momentum from completing its Early Claims Process and finalising my critical illness, disability and income protection claims relating to my cancer diagnosis. I have been waiting for feedback from Bankmed since the beginning of September, yet the matter remains unresolved. The continued delay is causing unnecessary additional stress at an already extremely difficult time. I urgently request that Bankmed: Escalate this matter immediately. Send the outstanding records to Momentum without further delay. Confirm in writing when the records have been sent. Provide an explanation for the delay and a complaint/escalation reference number. Bankmed, please treat this with the urgency and sensitivity that a cancer-related claim deserves.
1 reviews | Active since Dec 2021
Extremely poor service from both Bankmed and Clicks Pharmacy. On 21 August, I went to Clicks Pharmacy to obtain a device for my gynaecologist appointment. Clicks advised that my medical aid would not cover it and insisted I pay cash. I contacted Bankmed, who confirmed that it is covered. I returned to Clicks and waited over an hour while they tried to obtain the correct codes. The staff member assisting me was rude, unprofessional and continued insisting that I pay cash. With my appointment approaching, I had no choice but to pay. I submitted my invoice to Bankmed immediately. Since then, I have repeatedly been told they are trying to obtain the correct codes from Clicks. Over a month later, there is still no resolution or meaningful progress. I am extremely disappointed with the lack of accountability and poor service from both parties. I should not have had to pay out of pocket for a benefit that Bankmed confirmed is covered, nor should I still be chasing a resolution weeks later.
Pathetic service from the clicks pharmacy garden city and bankmed
1 reviews | Active since Dec 2021
Extremely poor service from both Bankmed and Clicks Pharmacy. On 21 August, I went to Clicks Pharmacy to obtain a device for my gynaecologist appointment. Clicks advised that my medical aid would not cover it and insisted I pay cash. I contacted Bankmed, who confirmed that it is covered. I returned to Clicks and waited over an hour while they tried to obtain the correct codes. The staff member assisting me was rude, unprofessional and continued insisting that I pay cash. With my appointment approaching, I had no choice but to pay. I submitted my invoice to Bankmed immediately. Since then, I have repeatedly been told they are trying to obtain the correct codes from Clicks. Over a month later, there is still no resolution or meaningful progress. I am extremely disappointed with the lack of accountability and poor service from both parties. I should not have had to pay out of pocket for a benefit that Bankmed confirmed is covered, nor should I still be chasing a resolution weeks later.
Pathetic service from the clicks pharmacy garden city and bankmed
1 reviews | Active since Nov 2022
Worst Customer Service and nothing is ever covered with them.
Bankmed is the worst and I wish I wasn't forced to be on this medical aid. We recently found out that my wife is pregnant and naturally what I did was to contact my medical aid. The simple response from them, its NOT COVERED? *** does that mean? This is my first child and I have no idea of how any of this works. I am freaking out but I'm also excited for this new chapter in my life just for Bankmed to come and **** all over it. No explanation as to why its not covered, no congratulationsn nothing. These people suck and they know nothing about customer service.
1 reviews | Active since Nov 2022
Worst Customer Service and nothing is ever covered with them.
Bankmed is the worst and I wish I wasn't forced to be on this medical aid. We recently found out that my wife is pregnant and naturally what I did was to contact my medical aid. The simple response from them, its NOT COVERED? *** does that mean? This is my first child and I have no idea of how any of this works. I am freaking out but I'm also excited for this new chapter in my life just for Bankmed to come and **** all over it. No explanation as to why its not covered, no congratulationsn nothing. These people suck and they know nothing about customer service.
1 reviews | Active since Jun 2015
More than 3 months waiting for my medical aid physical card
I have ordered a physical card for my medical more than 3 months ago and until now I have not received it , every time I phone to query I get told that I can use the digital card . I am anti smartphone so I cannot use a digital card , interesting enough money gets deducted for medical AID every month yet I cannot use it . Pathetic is an understatement , today I tried to logon to my online profile via my laptop . It says the profile is locked , I do not even get an option to unluck it . I do not remember being told that the minimum requirements of joining the scheme is having a smartphone , but now it appears as I cannot use the services I paying for because I do not have a smart phone .
1 reviews | Active since Jun 2015
More than 3 months waiting for my medical aid physical card
I have ordered a physical card for my medical more than 3 months ago and until now I have not received it , every time I phone to query I get told that I can use the digital card . I am anti smartphone so I cannot use a digital card , interesting enough money gets deducted for medical AID every month yet I cannot use it . Pathetic is an understatement , today I tried to logon to my online profile via my laptop . It says the profile is locked , I do not even get an option to unluck it . I do not remember being told that the minimum requirements of joining the scheme is having a smartphone , but now it appears as I cannot use the services I paying for because I do not have a smart phone .
1 reviews | Active since Nov 2022
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.
1 reviews | Active since Nov 2022
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.
1 reviews | Active since Mar 2019
Formal Complaint Regarding Preventative Childhood Dental Benefit Claim
Dear Sir/Madam, I hope this email finds you well. I am writing to lodge a formal complaint regarding the processing of a dental claim submitted in August 2026 for my child, Okuhle Sinqaba. In January 2026, Okuhle underwent a dental consultation under the Preventative Childhood Dental Check-Up Benefit, and the claim was correctly paid from the medical scheme benefit. According to the rules of this benefit, eligible child dependants qualify for two preventative childhood dental check-ups per year. When the same preventative procedure was performed on 29 August 2026, I was surprised to discover that the claim was paid from my Medical Savings Account (MSA) instead of the Scheme benefit. To clarify the matter, I contacted Bankmed on 24 August 2026 and spoke with Chandre, who confirmed that Okuhle qualifies for this benefit. I followed up again on 3 September 2026 and spoke with Mihlali, who advised that the matter would be investigated and that feedback would be provided by 8 September 2026. Unfortunately, no feedback or resolution was provided. Thereafter, I contacted the service centre and spoke with Nathaniel Grootboom. Regrettably, I found the interaction unsatisfactory, as he appeared unwilling to assist and advised that the matter would not be resolved despite my concerns. Meaningful assistance was only provided after I requested the complaints email address. On 12 September 2026, I received confirmation that the claim had been processed incorrectly. Given that the error has been acknowledged as an internal processing error, I firmly believe that I should not be financially prejudiced as a result. The claim should have been paid from the applicable Scheme benefit, as was the January 2026 claim, and not from my Medical Savings Account. For ease of reference: January 2026 claim: Preventative childhood dental check-up correctly paid from the medical scheme benefit. August 2026 claim: Same preventative benefit incorrectly paid from the Medical Savings Account (Reason Code 547: "We have paid the claim from your Medical Savings"). 12 September 2026: Confirmation received that the claim had been paid incorrectly. I therefore formally request that: The August 2026 dental claim be reviewed and reprocessed under the Preventative Childhood Dental Check-Up Benefit. The amount incorrectly deducted from my Medical Savings Account be reimbursed in full. Written confirmation be provided once the correction has been completed. I trust that Bankmed will rectify this matter promptly, as members should not be disadvantaged financially due to internal processing errors. I would appreciate urgent attention to this complaint and a written response outlining the corrective action taken. I look forward to your prompt resolution of this matter. January claim Claim detail Date of healthcare service Healthcare professional Practice type Amount claimed 2026-01-10 Dr D I Maringa Inc Dentist R 2,934.60 Payment details Amount paid Not paid Payment to Payment from Payment date R 1,908.00 R 1,993.40 Service provider The medical scheme 2026-01-15 (R 966.80) R 1,993.40 Service provider The medical scheme Amounts in brackets indicate a negative amount. View the original claims notification Breakdown of information for each part of the claim Date of healthcare service Patient name Amount claimed Scheme Reimbur*****t Rate Not paid Amount paid To you Healthcare professional Reason for short- or non-payment 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 59.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 966.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 966.80 R 966.80 R 0.00 R 0.00 321 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 0.00 R 0.00 R 59.80 2026-01-10 Okuhle Sinqaba R 204.10 R 212.20 R 0.00 R 0.00 R 204.10 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 0.00 R 0.00 R 966.80 2026-01-10 Okuhle Sinqaba (R 966.80) (R 1,005.40) R 0.00 R 0.00 (R 966.80) 36 2026-01-10 Okuhle Sinqaba (R 59.80) (R 62.00) R 0.00 R 0.00 (R 59.80) 36 2026-01-10 Okuhle Sinqaba R 121.60 R 126.40 R 0.00 R 0.00 R 121.60 2026-01-10 Okuhle Sinqaba R 177.50 R 184.60 R 0.00 R 0.00 R 177.50 2026-01-10 Okuhle Sinqaba R 311.10 R 323.50 R 0.00 R 0.00 R 311.10 2026-01-10 Okuhle Sinqaba R 59.80 R 59.80 R 0.00 R 0.00 R 59.80 321 2026-01-10 Okuhle Sinqaba R 67.10 R 69.80 R 0.00 R 0.00 R 67.10 Reason for short- or non-payment 320 We did not pay this claim line under the standard process. We reprocessed it as an exception. Please see the last claim line or the claim line with reason code 321 to see how we paid it. 321 We paid this amount as an exception. It is linked to a previous line that we processed differently (see reason code 320). 36 This is an adjustment of a claim that we have processed before.
1 reviews | Active since Mar 2019
Formal Complaint Regarding Preventative Childhood Dental Benefit Claim
Dear Sir/Madam, I hope this email finds you well. I am writing to lodge a formal complaint regarding the processing of a dental claim submitted in August 2026 for my child, Okuhle Sinqaba. In January 2026, Okuhle underwent a dental consultation under the Preventative Childhood Dental Check-Up Benefit, and the claim was correctly paid from the medical scheme benefit. According to the rules of this benefit, eligible child dependants qualify for two preventative childhood dental check-ups per year. When the same preventative procedure was performed on 29 August 2026, I was surprised to discover that the claim was paid from my Medical Savings Account (MSA) instead of the Scheme benefit. To clarify the matter, I contacted Bankmed on 24 August 2026 and spoke with Chandre, who confirmed that Okuhle qualifies for this benefit. I followed up again on 3 September 2026 and spoke with Mihlali, who advised that the matter would be investigated and that feedback would be provided by 8 September 2026. Unfortunately, no feedback or resolution was provided. Thereafter, I contacted the service centre and spoke with Nathaniel Grootboom. Regrettably, I found the interaction unsatisfactory, as he appeared unwilling to assist and advised that the matter would not be resolved despite my concerns. Meaningful assistance was only provided after I requested the complaints email address. On 12 September 2026, I received confirmation that the claim had been processed incorrectly. Given that the error has been acknowledged as an internal processing error, I firmly believe that I should not be financially prejudiced as a result. The claim should have been paid from the applicable Scheme benefit, as was the January 2026 claim, and not from my Medical Savings Account. For ease of reference: January 2026 claim: Preventative childhood dental check-up correctly paid from the medical scheme benefit. August 2026 claim: Same preventative benefit incorrectly paid from the Medical Savings Account (Reason Code 547: "We have paid the claim from your Medical Savings"). 12 September 2026: Confirmation received that the claim had been paid incorrectly. I therefore formally request that: The August 2026 dental claim be reviewed and reprocessed under the Preventative Childhood Dental Check-Up Benefit. The amount incorrectly deducted from my Medical Savings Account be reimbursed in full. Written confirmation be provided once the correction has been completed. I trust that Bankmed will rectify this matter promptly, as members should not be disadvantaged financially due to internal processing errors. I would appreciate urgent attention to this complaint and a written response outlining the corrective action taken. I look forward to your prompt resolution of this matter. January claim Claim detail Date of healthcare service Healthcare professional Practice type Amount claimed 2026-01-10 Dr D I Maringa Inc Dentist R 2,934.60 Payment details Amount paid Not paid Payment to Payment from Payment date R 1,908.00 R 1,993.40 Service provider The medical scheme 2026-01-15 (R 966.80) R 1,993.40 Service provider The medical scheme Amounts in brackets indicate a negative amount. View the original claims notification Breakdown of information for each part of the claim Date of healthcare service Patient name Amount claimed Scheme Reimbur*****t Rate Not paid Amount paid To you Healthcare professional Reason for short- or non-payment 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 59.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 966.80 R 0.00 R 0.00 320 2026-01-10 Okuhle Sinqaba R 966.80 R 966.80 R 966.80 R 0.00 R 0.00 321 2026-01-10 Okuhle Sinqaba R 59.80 R 62.00 R 0.00 R 0.00 R 59.80 2026-01-10 Okuhle Sinqaba R 204.10 R 212.20 R 0.00 R 0.00 R 204.10 2026-01-10 Okuhle Sinqaba R 966.80 R 1,005.40 R 0.00 R 0.00 R 966.80 2026-01-10 Okuhle Sinqaba (R 966.80) (R 1,005.40) R 0.00 R 0.00 (R 966.80) 36 2026-01-10 Okuhle Sinqaba (R 59.80) (R 62.00) R 0.00 R 0.00 (R 59.80) 36 2026-01-10 Okuhle Sinqaba R 121.60 R 126.40 R 0.00 R 0.00 R 121.60 2026-01-10 Okuhle Sinqaba R 177.50 R 184.60 R 0.00 R 0.00 R 177.50 2026-01-10 Okuhle Sinqaba R 311.10 R 323.50 R 0.00 R 0.00 R 311.10 2026-01-10 Okuhle Sinqaba R 59.80 R 59.80 R 0.00 R 0.00 R 59.80 321 2026-01-10 Okuhle Sinqaba R 67.10 R 69.80 R 0.00 R 0.00 R 67.10 Reason for short- or non-payment 320 We did not pay this claim line under the standard process. We reprocessed it as an exception. Please see the last claim line or the claim line with reason code 321 to see how we paid it. 321 We paid this amount as an exception. It is linked to a previous line that we processed differently (see reason code 320). 36 This is an adjustment of a claim that we have processed before.
1 reviews | Active since Jun 2024
Benefit for PMB cover rejected
I am responding to the correspondence dated the 31st of August 2026 as I realise the rejection to cover the pregnancy was based on admission to the hospital. The council of the Medical scheme rules states that PMB must be covered whether in or out of Hospital. I have previously added screenshots about this from the rules. Further I would like to understand the meaning of Necitating hospital and including delivery because in my understanding it means that the treatments of antenatal and obstetrics care leading the patient to be admitted and delivery in the future. For me the definition of "necitating" does not mean cover only in hospital, I would like the legal definition for the treatment under the code 52N to be fully detailed for me to accept the rejection of my pregnancy being declined as a PMB condition because the medical scheme seems to also be missing the rule that state that PMB MUST Be covered regardless of which medical aid option is taken. Your detailed response in addressing the above will be highly appreciated.
1 reviews | Active since Jun 2024
Benefit for PMB cover rejected
I am responding to the correspondence dated the 31st of August 2026 as I realise the rejection to cover the pregnancy was based on admission to the hospital. The council of the Medical scheme rules states that PMB must be covered whether in or out of Hospital. I have previously added screenshots about this from the rules. Further I would like to understand the meaning of Necitating hospital and including delivery because in my understanding it means that the treatments of antenatal and obstetrics care leading the patient to be admitted and delivery in the future. For me the definition of "necitating" does not mean cover only in hospital, I would like the legal definition for the treatment under the code 52N to be fully detailed for me to accept the rejection of my pregnancy being declined as a PMB condition because the medical scheme seems to also be missing the rule that state that PMB MUST Be covered regardless of which medical aid option is taken. Your detailed response in addressing the above will be highly appreciated.
1 reviews | Active since Oct 2013
Bankmed refused to cover anaesthesia for my 3-year-old’s dental procedure
I am extremely disappointed with how my medical aid has handled my 3-year-old son's dental treatment. My son has quite a few damaged teeth that need drilling and fillings. Because of his age and the amount of work that needs to be done, our dentist referred us to a hospital where the procedure could be done under anaesthesia. The dentist explained that trying to do all of this on a 3-year-old while he is awake would be extremely difficult and traumatic for him. Before going ahead, I called my medical aid, gave them the procedure code and was told that no authorisation was required and that we could proceed. We arrived at the hospital today, only to be told that they would cover the dental procedure but not the anaesthesiologist, because they believe the procedure can be done at a normal dentist. This makes absolutely no sense. If it could be done at a normal dentist, why was my 3-year-old referred to a hospital in the first place? Now they are asking for motivation from the doctor why this has to be done under anesthetic, you already have the information of the procedure that is going to be performed, you have my son's details, he is three, what motivation do you need honestly? I am extremely frustrated that I did everything I was supposed to do, contacted the medical aid beforehand and re**** on the information I was given, only to be told something completely different on the day of the procedure. We pay a lot every month for medical aid, and I honestly expected better communication and consideration when it comes to the treatment of a 3-year-old child. I really hope this matter is properly reviewed and resolved.
1 reviews | Active since Oct 2013
Bankmed refused to cover anaesthesia for my 3-year-old’s dental procedure
I am extremely disappointed with how my medical aid has handled my 3-year-old son's dental treatment. My son has quite a few damaged teeth that need drilling and fillings. Because of his age and the amount of work that needs to be done, our dentist referred us to a hospital where the procedure could be done under anaesthesia. The dentist explained that trying to do all of this on a 3-year-old while he is awake would be extremely difficult and traumatic for him. Before going ahead, I called my medical aid, gave them the procedure code and was told that no authorisation was required and that we could proceed. We arrived at the hospital today, only to be told that they would cover the dental procedure but not the anaesthesiologist, because they believe the procedure can be done at a normal dentist. This makes absolutely no sense. If it could be done at a normal dentist, why was my 3-year-old referred to a hospital in the first place? Now they are asking for motivation from the doctor why this has to be done under anesthetic, you already have the information of the procedure that is going to be performed, you have my son's details, he is three, what motivation do you need honestly? I am extremely frustrated that I did everything I was supposed to do, contacted the medical aid beforehand and re**** on the information I was given, only to be told something completely different on the day of the procedure. We pay a lot every month for medical aid, and I honestly expected better communication and consideration when it comes to the treatment of a 3-year-old child. I really hope this matter is properly reviewed and resolved.