NM
Naledi M
1 reviews | Active since Jul 2023
21 Sept 2023, 11:51
best did me dirty.
bestmed never pays for any claim in full. There is a shortfall on every claim. These people have lost sense of shame. How are you the award winning medical scheme when there is no claim of mine paid in full? Unless I'm the target of **************. It started when you rejected the extension of my admission days. I visit either a GP or specialist almost every weekend because I had not recovered when I got discharged. One of your consultant said it's because of the plan I'm on. I asked her is there any hospital plan higher than the one I'm on, she said NO. So what now? When I was with Discovery I paid no cent from my pocket. Was with Discovery for almost 4 years and switching to bestmed is my biggest regret.
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Replies (8)0
Replies (8)
Bestmed Medical Scheme's replyOfficial
21 Sept 2023, 14:24Dear Naledi Modisanyane
Please be informed that the scheme covers 100% of the scheme rate for both in-hospital and out-of-hospital claims.
We received the request to extend your hospital stay, which was granted. We initially approved eight days; on 17/07/2023, we extended this to 9.5 days, as requested.
It is important to note that the Beat1 option is a hospital plan; it does not include savings or day-to-day benefits. Therefore, out-of-hospital consultations will not be covered.
Lastly, your claims for Dr. Muvhango and Dr. Wheeler have been sent for PMB review. Once these claims are finalised, we will provide you with feedback.
Regards
Nondumiso Letsoalo
Please be informed that the scheme covers 100% of the scheme rate for both in-hospital and out-of-hospital claims.
We received the request to extend your hospital stay, which was granted. We initially approved eight days; on 17/07/2023, we extended this to 9.5 days, as requested.
It is important to note that the Beat1 option is a hospital plan; it does not include savings or day-to-day benefits. Therefore, out-of-hospital consultations will not be covered.
Lastly, your claims for Dr. Muvhango and Dr. Wheeler have been sent for PMB review. Once these claims are finalised, we will provide you with feedback.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply21 Sept 2023, 14:24
Official
Dear Naledi Modisanyane
Please be informed that the scheme covers 100% of the scheme rate for both in-hospital and out-of-hospital claims.
We received the request to extend your hospital stay, which was granted. We initially approved eight days; on 17/07/2023, we extended this to 9.5 days, as requested.
It is important to note that the Beat1 option is a hospital plan; it does not include savings or day-to-day benefits. Therefore, out-of-hospital consultations will not be covered.
Lastly, your claims for Dr. Muvhango and Dr. Wheeler have been sent for PMB review. Once these claims are finalised, we will provide you with feedback.
Regards
Nondumiso Letsoalo
Please be informed that the scheme covers 100% of the scheme rate for both in-hospital and out-of-hospital claims.
We received the request to extend your hospital stay, which was granted. We initially approved eight days; on 17/07/2023, we extended this to 9.5 days, as requested.
It is important to note that the Beat1 option is a hospital plan; it does not include savings or day-to-day benefits. Therefore, out-of-hospital consultations will not be covered.
Lastly, your claims for Dr. Muvhango and Dr. Wheeler have been sent for PMB review. Once these claims are finalised, we will provide you with feedback.
Regards
Nondumiso Letsoalo
NM
Naledi M's updateReviewer Update
23 Sept 2023, 14:30Now Badmed is teaching it's employees to lie. Nondumiso Letsoalo you have no shame to come to this platform and lie. My hospital stay was never extended and brain MRI was never approved. I called myself while I was on that hospital bed and according to your consultants I was supposed to be discharged. I never said anything about the day to day bene
NM
Naledi M's update23 Sept 2023, 14:30
Reviewer Update
Now Badmed is teaching it's employees to lie. Nondumiso Letsoalo you have no shame to come to this platform and lie. My hospital stay was never extended and brain MRI was never approved. I called myself while I was on that hospital bed and according to your consultants I was supposed to be discharged. I never said anything about the day to day bene
NM
Naledi M's updateReviewer Update
23 Sept 2023, 14:54Now Badmed is teaching it's employees to lie. Nondumiso Letsoalo you have no shame to come to this platform and lie. My hospital stay was never extended and brain MRI was never approved. I called myself while I was on that hospital bed and according to your consultants I was supposed to be discharged. I never said anything about the day to day benefits, I know I'm on hospital plan but you had to bring it up because you know Badmed is the reason I have to visit specialist almost every weekend because what I'm experiencing right now could have been prevented had my stay been extended. You want to make it seem like your not responsible for that, yet you are responsible for that. You can't even pay mere R2000.00 claim in full. You cannot proudly call this a hospital plan this is more like a medical insurance even on your website it must be changed to medical insurance. And medical insurances are way cheaper than your premiums for the same benefits your are offering. You are misleading people!! Dr. Muvhango and Dr. Wheeler been waiting for over 60 days for you to settle the claim and it's still not done. Me and you know that if it's not paid within 60 days it has to be paid by me. You just responding to impress the public instead of resolving this matter. I need the limit of each and every claim to be sent to me so I can make informed decisions and I'm entitled to know. May you not make me wait longer than 2 working days please.
NM
Naledi M's update23 Sept 2023, 14:54
Reviewer Update
Now Badmed is teaching it's employees to lie. Nondumiso Letsoalo you have no shame to come to this platform and lie. My hospital stay was never extended and brain MRI was never approved. I called myself while I was on that hospital bed and according to your consultants I was supposed to be discharged. I never said anything about the day to day benefits, I know I'm on hospital plan but you had to bring it up because you know Badmed is the reason I have to visit specialist almost every weekend because what I'm experiencing right now could have been prevented had my stay been extended. You want to make it seem like your not responsible for that, yet you are responsible for that. You can't even pay mere R2000.00 claim in full. You cannot proudly call this a hospital plan this is more like a medical insurance even on your website it must be changed to medical insurance. And medical insurances are way cheaper than your premiums for the same benefits your are offering. You are misleading people!! Dr. Muvhango and Dr. Wheeler been waiting for over 60 days for you to settle the claim and it's still not done. Me and you know that if it's not paid within 60 days it has to be paid by me. You just responding to impress the public instead of resolving this matter. I need the limit of each and every claim to be sent to me so I can make informed decisions and I'm entitled to know. May you not make me wait longer than 2 working days please.
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 09:32Dear Naledi Modisanyane
Please be informed that I have emailed you the authorisation letter, which was also sent to the service providers on 14/07/2023, to confirm the update on the length of stay.
Regarding the MRI scan conducted in the hospital, our case manager, whom you spoke with on 12/07/2023, informed you that, per the scheme protocol and funding guidelines, an MRI scan for migraines falls under the out-of-hospital benefits.
The claims for Dr. Muvhango and Dr. Wheeler were processed and paid within five days from their submission date.
As we discussed earlier, these claims were paid at the scheme rate. However, it's worth noting that both doctors have billed above the scheme rate, so we have forwarded both claims for PMB review.
Regards
Nondumiso Letsoalo
Please be informed that I have emailed you the authorisation letter, which was also sent to the service providers on 14/07/2023, to confirm the update on the length of stay.
Regarding the MRI scan conducted in the hospital, our case manager, whom you spoke with on 12/07/2023, informed you that, per the scheme protocol and funding guidelines, an MRI scan for migraines falls under the out-of-hospital benefits.
The claims for Dr. Muvhango and Dr. Wheeler were processed and paid within five days from their submission date.
As we discussed earlier, these claims were paid at the scheme rate. However, it's worth noting that both doctors have billed above the scheme rate, so we have forwarded both claims for PMB review.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 09:32
Official
Dear Naledi Modisanyane
Please be informed that I have emailed you the authorisation letter, which was also sent to the service providers on 14/07/2023, to confirm the update on the length of stay.
Regarding the MRI scan conducted in the hospital, our case manager, whom you spoke with on 12/07/2023, informed you that, per the scheme protocol and funding guidelines, an MRI scan for migraines falls under the out-of-hospital benefits.
The claims for Dr. Muvhango and Dr. Wheeler were processed and paid within five days from their submission date.
As we discussed earlier, these claims were paid at the scheme rate. However, it's worth noting that both doctors have billed above the scheme rate, so we have forwarded both claims for PMB review.
Regards
Nondumiso Letsoalo
Please be informed that I have emailed you the authorisation letter, which was also sent to the service providers on 14/07/2023, to confirm the update on the length of stay.
Regarding the MRI scan conducted in the hospital, our case manager, whom you spoke with on 12/07/2023, informed you that, per the scheme protocol and funding guidelines, an MRI scan for migraines falls under the out-of-hospital benefits.
The claims for Dr. Muvhango and Dr. Wheeler were processed and paid within five days from their submission date.
As we discussed earlier, these claims were paid at the scheme rate. However, it's worth noting that both doctors have billed above the scheme rate, so we have forwarded both claims for PMB review.
Regards
Nondumiso Letsoalo
NM
Naledi M's updateReviewer Update
26 Sept 2023, 12:34They trained you well. You still continue to lie. Nondumiso why did you not email that authorization letter when I contacted to you on the 9th or 10th day? Is this how *********** you can be even when it comes to somebody else's life? I made millions calls on that day even the hospital told me my extension was not approved. Don't come me here and lie, that authorization letter must be forged. Regarding the brain MRI, that will be your homework for today, go and read my previous complaints. You don't have MRI benefits stop misleading people, I repeat you don't have brain MRI benefits. Why should I do the MRI as outpatient when you made it clear that I'm only covered when I'm hospitalized? What's so special about MRI that I should do it as outpatient? Because you know you are running away from paying the full amount as per usual. Change that hospital plan to medical insurance.you have no shame in telling me that DRs billed above scheme rate. That claim is around R2000.00 even the medical insurance would have paid that. I'm still waiting for a list of everything. I want to know the scheme rate of each and every claim or everything on your catalogue. Lots of information is omitted on your catalogue just so you can lure people to join you.
NM
Naledi M's update26 Sept 2023, 12:34
Reviewer Update
They trained you well. You still continue to lie. Nondumiso why did you not email that authorization letter when I contacted to you on the 9th or 10th day? Is this how *********** you can be even when it comes to somebody else's life? I made millions calls on that day even the hospital told me my extension was not approved. Don't come me here and lie, that authorization letter must be forged. Regarding the brain MRI, that will be your homework for today, go and read my previous complaints. You don't have MRI benefits stop misleading people, I repeat you don't have brain MRI benefits. Why should I do the MRI as outpatient when you made it clear that I'm only covered when I'm hospitalized? What's so special about MRI that I should do it as outpatient? Because you know you are running away from paying the full amount as per usual. Change that hospital plan to medical insurance.you have no shame in telling me that DRs billed above scheme rate. That claim is around R2000.00 even the medical insurance would have paid that. I'm still waiting for a list of everything. I want to know the scheme rate of each and every claim or everything on your catalogue. Lots of information is omitted on your catalogue just so you can lure people to join you.
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 16:04Dear Naledi Modisanyane
The letter was sent to ***, and I have responded to your latest email.
Regards
Nondumiso Letsoalo
The letter was sent to ***, and I have responded to your latest email.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 16:04
Official
Dear Naledi Modisanyane
The letter was sent to ***, and I have responded to your latest email.
Regards
Nondumiso Letsoalo
The letter was sent to ***, and I have responded to your latest email.
Regards
Nondumiso Letsoalo
NM
Naledi M's updateReviewer Update
27 Sept 2023, 09:05You only sending the authorization letter after how many month of me being discharged? Why did you not send it then? I was at the hospital for 10 days and the 10th day the Dr told me they discharging me because they tried to extend my stay but unfortunately it was declined. It means the Dr tried to extend my admission for longer than 10 days but you did not approve it. You can lie on this platform yerrrr. How is that authorization letter for 9.5 days helping me now when I got discharged before I was even ready to go home?
NM
Naledi M's update27 Sept 2023, 09:05
Reviewer Update
You only sending the authorization letter after how many month of me being discharged? Why did you not send it then? I was at the hospital for 10 days and the 10th day the Dr told me they discharging me because they tried to extend my stay but unfortunately it was declined. It means the Dr tried to extend my admission for longer than 10 days but you did not approve it. You can lie on this platform yerrrr. How is that authorization letter for 9.5 days helping me now when I got discharged before I was even ready to go home?
Bestmed Medical Scheme's replyOfficial
27 Sept 2023, 09:24Dear Naledi Modisanyane
If you believe that our response isn't truthful or are unsatisfied with our feedback, you can escalate your complaint to the Council for Medical Schemes. I've sent their contact details to your email.
Regards
Nondumiso Letsoalo
If you believe that our response isn't truthful or are unsatisfied with our feedback, you can escalate your complaint to the Council for Medical Schemes. I've sent their contact details to your email.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply27 Sept 2023, 09:24
Official
Dear Naledi Modisanyane
If you believe that our response isn't truthful or are unsatisfied with our feedback, you can escalate your complaint to the Council for Medical Schemes. I've sent their contact details to your email.
Regards
Nondumiso Letsoalo
If you believe that our response isn't truthful or are unsatisfied with our feedback, you can escalate your complaint to the Council for Medical Schemes. I've sent their contact details to your email.
Regards
Nondumiso Letsoalo