Bestmed refuses to pay valid PMB claims

We joined Bestmed in 2018. Over the past eight years, we have paid well over R400k in premiums, and claimed for two small items, at a total of approx R10k. In May, I had a bad fall at work and broke my wrist. This is a PMB, and Bestmed was required by law to cover the surgery. However, from the outset, every claim was rejected or short-paid. Every single supplier – hospital, surgeon, anaesthetist, radiology – has had to resubmit each claim with a motivation, even though it was all pre-authorised. It seems to me that this is Bestmed’s strategy, to avoid settling claims. They simply hope that suppliers and clients will give up and go away. I have been left with hospital bills that I have had to pay, as Bestmed simply rejects those items, for groundless reasons. I have phoned and emailed repeatedly, but each time I am given fob-offs and excuses. One reason I was given is that the emergency code doesn’t apply as I had my surgery within 24 hours, but not within 2 hours. This is absolute nonsense, and does not comply with the law. It is also patently ridiculous, as the rest of the invoice was emergency coded, as indeed it should be, and Bestmed paid for those items. In another instance, they tried to tell me that the hospital claim was outside the emergency window. I checked with the hospital, and they had indeed misdated the item, so I got that error corrected and resent the invoice. However, they rejected it once again, this time saying that the hospital can’t charge for those items, as they are a standard part of admission. These were surgical items – nothing to do with admission. Bestmed is dishonest and disgusting. If I could give a zero star, I would.