DP
Dwyann P
1 reviews | Active since Oct 2019
22 Jan 2025, 11:50
Bestmed employees are ****s and *****s, they do not stick to what was said.
I fell ill during the December period back in 2022, we are currently in 2025. when the doc had told me that i need to stay longer to be monitored, i phoned bestmed and was told it is covered and i am not liable for anything. come December 2024, i get a court doc stating i own money to the hospital. i then queried with bestmed and they said the claim is stale, and that the email from there employee was incorrect and that i am liable and need to pay it. this is not my fault, because i was told by the bestmed employee it will be covered. this is the worst medical aid, how can staff say something but management says they will deal with the employee but i am still liable. i had numerous email sent and calls to them to speak to a manger to resolve this matter or i wil go to court. it is not on me that the bestmed employee made an error, bestmed should stick to what was said by there employee. i have all the proof and the call recording and i will take it further if this not resolved urgently and i will go on social platforms letting people know what *****sters and ****s they are.
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Bestmed Medical Scheme's replyOfficial
28 Jan 2025, 11:34Dear Dwyann ,
Thank you for reaching out and allowing us the opportunity to address your concerns regarding the outstanding hospital bill. We have carefully reviewed your case, and I would like to clarify the circumstances surrounding this matter.
Thank you for reaching out and allowing us the opportunity to address your concerns regarding the outstanding hospital bill. We have carefully reviewed your case, and I would like to clarify the circumstances surrounding this matter.
At the time of your admission in December 2022, our team correctly confirmed that the admission would be covered at 100% of the scheme tariff, subject to authorization. Authorization for your admission was granted. However, the hospital billing submitted did not align with the authorization provided. It is the responsibility of the hospital to ensure that billing corresponds with the authorization or to provide updated clinical information to justify any adjustments.
In this case, we requested clinical updates from the hospital to adjust the length of your stay. Unfortunately, the necessary feedback was not received. Our last follow-up with the hospital regarding these updates was sent on 20 April 2023. As the required information was not provided within the specified time frame, the claim subsequently became stale in line with the Scheme’s rules.
To clarify, Rule 15.3 of the Scheme states:
- Claims must be submitted within four months following the month in which the health service was rendered.
- Where the Scheme is of the opinion that an account, statement or claim is erroneous or unacceptable for payment, the Scheme shall notify the Member and the healthcare service provider accordingly, within 30 (thirty) days after receipt thereof. The Scheme shall state the reasons why such account, statement or claim is regarded as erroneous or unacceptable and afford such Member and provider the opportunity to correct and resubmit such account, statement or claim to the Scheme within 60 (sixty) days following the date from which the aforesaid account was returned for correction.
The hospital only queried or followed up on this claim in December 2024—nearly 24 months after the date of admission. As such, any further updates or adjustments were declined due to the claim's staleness. This matter does not pertain to an error in benefit confirmation but rather to the hospital’s responsibility to provide the necessary information within the stipulated timelines.
We understand your frustration and empathize with your position. However, we encourage you to address this matter directly with the hospital, as they are best placed to resolve discrepancies in their billing.
With Kind Regards
KS
With Kind Regards
KS
Bestmed Medical Scheme's reply28 Jan 2025, 11:34
Official
Dear Dwyann ,
Thank you for reaching out and allowing us the opportunity to address your concerns regarding the outstanding hospital bill. We have carefully reviewed your case, and I would like to clarify the circumstances surrounding this matter.
Thank you for reaching out and allowing us the opportunity to address your concerns regarding the outstanding hospital bill. We have carefully reviewed your case, and I would like to clarify the circumstances surrounding this matter.
At the time of your admission in December 2022, our team correctly confirmed that the admission would be covered at 100% of the scheme tariff, subject to authorization. Authorization for your admission was granted. However, the hospital billing submitted did not align with the authorization provided. It is the responsibility of the hospital to ensure that billing corresponds with the authorization or to provide updated clinical information to justify any adjustments.
In this case, we requested clinical updates from the hospital to adjust the length of your stay. Unfortunately, the necessary feedback was not received. Our last follow-up with the hospital regarding these updates was sent on 20 April 2023. As the required information was not provided within the specified time frame, the claim subsequently became stale in line with the Scheme’s rules.
To clarify, Rule 15.3 of the Scheme states:
- Claims must be submitted within four months following the month in which the health service was rendered.
- Where the Scheme is of the opinion that an account, statement or claim is erroneous or unacceptable for payment, the Scheme shall notify the Member and the healthcare service provider accordingly, within 30 (thirty) days after receipt thereof. The Scheme shall state the reasons why such account, statement or claim is regarded as erroneous or unacceptable and afford such Member and provider the opportunity to correct and resubmit such account, statement or claim to the Scheme within 60 (sixty) days following the date from which the aforesaid account was returned for correction.
The hospital only queried or followed up on this claim in December 2024—nearly 24 months after the date of admission. As such, any further updates or adjustments were declined due to the claim's staleness. This matter does not pertain to an error in benefit confirmation but rather to the hospital’s responsibility to provide the necessary information within the stipulated timelines.
We understand your frustration and empathize with your position. However, we encourage you to address this matter directly with the hospital, as they are best placed to resolve discrepancies in their billing.
With Kind Regards
KS
With Kind Regards
KS