Bestmed having a poor claims department, and does not pay for crucial bloodtest

Dear Bestmed Customer Service,

I am writing to express my deep dissatisfaction with the handling of a recent claim involving a critical blood test performed by PathCare following an emergency visit to BayView Hospital for severe gastric distress.

Despite the medical necessity and urgency of the test, Bestmed has failed to settle the PathCare account. After numerous follow-ups with PathCare — which, as the patient, should not be my responsibility — the statement continued to reflect “under monitoring for possible non-disclosure,” with no meaningful explanation or resolution.

After spending over an hour on hold with your claims call center — time I cannot afford to lose as a self-employed individual — I was informed that the claim was submitted under a psychiatric code related to a so-called “pre-existing condition.” This is inaccurate and inappropriate, as the treatment was for acute gastral pain and related symptoms, not a psychiatric matter.

This raises several concerns:

Incorrect ICD-10 Coding: The use of a psychiatric code for a gastrointestinal issue is a clear administrative error.

Lack of Communication: Neither Bestmed nor PathCare has contacted me to clarify or resolve this.

Unfair Burden on Patient: I have had to act as a liaison between providers, which is not the responsibility of the patient.

Unpaid Medical Account: This may affect my credit record or lead to unnecessary legal action, all due to an error beyond my control.

I respectfully request:

A formal investigation into how this coding error occurred.

Immediate communication between Bestmed and PathCare to resolve this claim.

Written confirmation that I will not be held liable for a bill resulting from an error made by medical administration.

If this is not resolved promptly, I will consider escalating the matter to the Council for Medical Schemes (CMS) and the Health Professions Council of South Africa (HPCSA), as this has now become a matter of both financial and ethical concern.

I appreciate your urgent attention to this matter and look forward to a written response within 5 business days.

Sincerely, Marthinus Steph**** Matthysen ID number: *** +***