Bestmed failed me during cancer treatment – CMS ruled in my favour

I was a Bestmed member when I was diagnosed with high-risk early-stage breast cancer. My oncologist first app**** for my prescribed treatment, Abemaciclib (Yuraleb), in August 2024.

From August 2024 until April 2025, I tried to get approval. Bestmed kept giving me different reasons for declining: first that my plan didn’t cover it, then that I didn’t meet the criteria, then that it wasn’t in the ICON protocol. Out of desperation, I even tried to upgrade my plan voluntarily in the hopes of getting access, but Bestmed declined that too. All the while I was paying full premiums, under stress, and denied treatment I urgently needed.

I took the matter to the Council for Medical Schemes (CMS). On 12 August 2025, CMS ruled in my favour, confirming that Bestmed’s refusal created an unreasonable barrier to care. CMS ordered Bestmed to fund Yuraleb under Regulation 15H(c) and confirmed I should never have had to upgrade to qualify.

By then I had already left Bestmed out of frustration and moved to Discovery. Discovery approved the same treatment within one week of application, without any issues.

On 22 August 2025, I also wrote to Bestmed requesting partial refunds of my premiums for the period I was denied cover. To date, I have received no acknowledgement or response.

I am posting this review to warn other members: if you are struggling with oncology approvals, don’t accept the first denial. Know your rights under the Medical Schemes Act and take your case to CMS if necessary.