AS
Arisa S

1 reviews | Active since May 2011

28 Jul 2015, 14:02

Bestmed makes empty promise to pay claim

I had called Bestmed client services department twice in one day to confirm if a procedure that I wanted to have would be paid for by the medical aid and if I required pre-authorisation even though the procedure was done in the doctors rooms. I called and spoke to two different consultants and gave them the codes for the procedure. I also gave them the practice number. I was assured that everything would be covered by Bestmed and that I do not require pre-authorisation. I even asked the consultants if I needed to send in the motivation letter from the doctor and they said that they do not require it. The consultants also agreed that I would be reimbursed by Bestmed if I paid for the procedure myself and then sent the claim through. (Ref numbers for the calls: *** and ***). Now Bestmed has rejected the claim (No hospital authorisation obtained). I have queried this and every time I call they tell me that it has been escalated to management. So yesterday I spoke to a consultant (Name: Fundi) and asked to speak to her team leader and her team leader refused to speak to me. She just passed the message that it has been escalated and management has to listen to the calls.

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Replies (1)
Bestmed Medical Scheme
Bestmed Medical Scheme's reply28 Jul 2015, 14:05
Official
Hello Ari,

Thank you for taking the time to bring your complaint to our attention. The contents have been noted and we are currently investigating the issue.

Please note that the complaint will be handled and responded to by an Escalation Specialist. If however, you need more information, do not hesitate to contact us.

Your wellbeing, as a valued client of the Scheme, is important to all of us at Bestmed.

With kind regards
Bestmed Medical Scheme