BestMed is *********

I recently needed surgery for the removal of my wisdom teeth before the surgery I was in contact with my medical aid to confirm if they will cover everything.

I sent them the quote from my surgeon where he quoted an amount of R6012.09 for the surgery. This was all sent to my medical aid and they preapproved his quote for R6012.09 . I was told dental surgery is covered up to R6800 per family never was I told of scheme tariffs and only small portion per tooth would be paid etc placing me under the impression there is enough cover for the R6012.09 never telling me there would be a portion I would have to pay after being well aware what the surgeon is quoting and what they cover. Or what amount of the quoted invoice are scheme tariffs.

In light of above mentioned we proceeded to book the surgery for the 9th of April and on the 9th of April at around 11am I was admitted to intercare day hospital and the surgery was done.

Once the surgery was done the medical bills came in and to my shock the medical aid now decided to not cover much of the procedure. They only paid a small portion of the R6012.09 that was quoted to them and that they pre-approved.

How can they now not be willing to pay the quoted R6012.09 after the quote was sent to them and pre-approved, if they were not going to pay the full R6012.09 why did they not advise me beforehand nowhere on their pre-approval did they advise of a co-payment that I will have to pay , if I was aware of all this beforehand I would not have had the procedure done. I was placed under false impressions.

They were well aware of the quoted amount before hand and well aware what their scheme tariffs are but conveniently forgot to disclose this very important fact to me. Their Non Disclosure now leading to my suffering.