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Arlene O
1 reviews | Active since Feb 2021
22 Sept 2025, 10:08
BESTMED CLAIMS AND AUTHORIZATION COMMITTEE QUESTIONABLE
I was recently diagnosed with a PMB condition, and have struggled for 4 weeks to get a radiology claim paid. Weekly, I am told the payment will be next week. It turns out payment is only due to me on the 30th September. Claim submitted 20 August, payment to be 30 September. 6 weeks to refund me for a PMB condition. On top of that, the authorization committee only approved removal of one lesion.. 2 cancerous lesions, but they only approve for one to be removed, even though doctor motivated for two. I am beyond words.
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Bestmed Medical Scheme's replyOfficial
22 Sept 2025, 15:20Dear Arlene
We sincerely apologise for the frustration and inconvenience you have experienced regarding your claim and authorisation process.
Kindly note that since 2024, payments for pathologists, radiologists, and hospitals are processed twice a month. As a result, the next payment run for radiology is scheduled for 30 September 2025, which explains the delay you encountered despite your claim having been submitted on 20 August 2025.
Regarding the authorisation for the removal of lesions, please be assured that communication relating to the approval of the one lesion has been sent to the Pre-authorisation Department, who will provide you with further feedback and guidance directly.
Kind Regards
GM
GM
Bestmed Medical Scheme's reply22 Sept 2025, 15:20
Official
Dear Arlene
We sincerely apologise for the frustration and inconvenience you have experienced regarding your claim and authorisation process.
Kindly note that since 2024, payments for pathologists, radiologists, and hospitals are processed twice a month. As a result, the next payment run for radiology is scheduled for 30 September 2025, which explains the delay you encountered despite your claim having been submitted on 20 August 2025.
Regarding the authorisation for the removal of lesions, please be assured that communication relating to the approval of the one lesion has been sent to the Pre-authorisation Department, who will provide you with further feedback and guidance directly.
Kind Regards
GM
GM