JM
Josephine M

1 reviews | Active since Mar 2018

27 Aug 2019, 10:11

Bestmed PMB application gone wrong

am with the medical aid under the Beat 2 option, been with them for a year now, in June i went for a routine check up with my GP again being i was experiencing some discomfort on my left abdominal side, he did checks and a sonar, it discovered i have a Cyst on my left ovary and fibroids ..he then had to refer me to a Gynae because he said he can't do much for me , which is where the problem started because the option am on doesn't cover gynae visits, i called the medical aid customer care about three times before i was helped with an PMB application, which i did fill with my GP, and after submission , the medical approved the PMB application with my GP details, i understand we made a mistake in section "E" of the application as it required the details of the Gynae , and we (My GP and I) put that of the GP, but how does the medical aid approve something that i already have access to? i have access to go the GP so if we made a mistake on the PMB why approve it under the GP and the GP included his Practice number and that of the Gynae plus supporting documents of the results of the scan , so why couldn't they see or rather call my GP for clarity of which doctor are we applying the PMB for? instead of approving it under the GP who is not a Gynae yet we applying for a Gynae visit? My problem right now is i have to sub,it another PMB and for me to do that i must go consult with the gynae (which doesn't make sense to me because the medical doesn't cover for the gynae consultation thus the PMB application, am sitting with this excruciating pain till the medical can decide if am worth me getting the help .. i wish it was possible i can change medical aid but at work we only allowed to change medical aid end of the year,

Why couldn't Bestmed ask my GP if the application wasn't clear instead of approving if with his details though he is not a GP? I love to think they have practice number of all doctors they work with , and if they do why approve my PMB under the doctor who is not a Gynae yet my application clearly stated am applying for the Gynae Consultations? I feel numb and in pain and scared with every day that passes the cyst is getting bigger, i live on pain medication to make the pain bearable .. Thanks to Bestmed

0
Replies (5)
Bestmed Medical Scheme
Bestmed Medical Scheme's reply27 Aug 2019, 10:53
Official
Good day Ms Montoeli

The Beat2 option on which you are registered as a member of Bestmed is basically a hospital plan with a very limited annual Medical Savings Account for out-of-hospital services.  Out-of-hospital PMB services do need to be app**** for on the Scheme's prescribed form for this purpose.  I will look at the application form received from your GP and will respond to your complaint via ***
JM
Josephine M's update27 Aug 2019, 14:29
Reviewer Update
Yes am aware thus we app**** for the PMB for me to be able to go see the Gynae ,
but the issue came when we made a mistake in Section "E" of the application where my doctor put his details instead of those of the Gynae " Doctor applying for the Service" and i get it was suppose to be that of the Gynae but how do i go to the gynae for him to fill the form if the meical doesn't cover for gynae visits? and couldn't the person capturing the application see from the practice number that the details on the 'doctor applying for the service " is that of the GP and not the Gynae?the least they could have done was to call and ask? that's all
Bestmed Medical Scheme
Bestmed Medical Scheme's reply28 Aug 2019, 08:13
Official
Good day Ms Montoeli

Our PMB Department is currently reviewing the application.

They will provide you with feedback as soon as they have concluded their investigation.

With kind regards.

Bestmed
JM
Josephine M's update28 Aug 2019, 15:59
Reviewer Update
I had the pleasure of speaking to Lorato Mdau from the PMB department and she explained to me in detail what the procedure of the application , also advised to request to speak directly with the department you inquiring about as it saves a lot of headache .
Thank you very much Lorato Mdau for your help today and patience with me , you really treated me like a person and not just a client ,
I will be getting the help i need and you made it all possible.

Thank you a million time
Bestmed Medical Scheme
Bestmed Medical Scheme's reply29 Aug 2019, 08:06
Official
Good day Ms Montoeli

We certainly find ourselves in a world more prone to complaining than complimenting. Thank you so much for taking the time to place in writing your positive response to a Service Excellence Experience at Bestmed, it is greatly appreciated.  There is no better inspiration for our staff than to receive spontaneous praise and for this, we sincerely thank you.  Please be assured that this particular compliment will be acknowledged and appreciated in our midst.  Thank you for your involvement in and for supporting the business of Bestmed. 

Bestmed