CK
Christopher K
1 reviews | Active since Nov 2011
03 Jul 2024, 18:49
BestMed Refusing to pay for Blood Tests
I have been sick, and as part of finding out what the issue is, the Dr decided to do an allergy blood test. Pathcare charged R6,714.20 for this allergy test and Bestmed only paid R2,538.90. I am now expected to pay R4,175.30 from my own pocket. We pay medical aid such exorbitant fees for them to refuse claims like that. I am so disappointed with treatment that I am getting from Bestmed. How is the Dr then going to know what to treat if they are refusing to pay for such a basic service? I am going to cancel my membership with them and move to my partner's medical aid since they are failing to pay for such basic services. How are the medical doctors supposed to find the root cause of the illness if medical aids do not cover blood tests? This should be part of the basic cover. What is the point of having medical insurance if I have to pop up from my very own pocket such a huge amount? This is a daylight ******* Bestmed. I am also going to escalate my complaint to the Medical Aid Ombudsman. Anyone who is considering joining BestMed, please stay away from them and consider other medical aids; these are ******.
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Replies (3)0
Replies (3)
Bestmed Medical Scheme's replyOfficial
04 Jul 2024, 09:27Dear Christopher,
Thank you for contacting Bestmed regarding your recent claim. We understand your frustration with the outcome of the claim, and we sincerely apologize for any inconvenience caused.
We've reviewed your claim and plan details and we'd like to clarify how out-of-hospital services are covered under your chosen Bestmed plan.
In this instance, both your annual savings and day-to-day benefits have been depleted for the year. This explains why Bestmed wasn't able to cover the full cost of the allergy blood test.
in addition, Bestmed covers the diagnosis, treatment and care costs of Prescribed Minimum Benefits (PMBs).
This includes the provision of diagnosis, treatment, and care costs for:
It is important to note that Bestmed offers 11 different medical aid plans to cater to a variety of member needs and budgets. These plans may have varying coverage levels for out-of-hospital services, including pathology tests.
We sincerely apologize for any inconvenience this may cause. We understand the importance of having access to necessary tests for diagnosis and treatment.
We recommend reviewing your plan brochure or contacting our member support team to discuss your specific coverage details and explore options that might better suit your healthcare needs.
I trust you will find this feedback useful. If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us on ***. Your wellbeing, as a valued client of the Scheme, is important to all of us at Bestmed.
With Kind Regards,
Bestmed Medical Scheme
Thank you for contacting Bestmed regarding your recent claim. We understand your frustration with the outcome of the claim, and we sincerely apologize for any inconvenience caused.
We've reviewed your claim and plan details and we'd like to clarify how out-of-hospital services are covered under your chosen Bestmed plan.
- Under your chosen Bestmed plan option, out-of-hospital services, including pathology tests like your allergy blood test, are initially paid from your annual medical savings account.
- Once the annual savings are depleted, coverage continues from your day-to-day benefit (High-Risk Benefit). This benefit covers basic services like pathology tests, consultations, and treatment, but up to a specific limit.
In this instance, both your annual savings and day-to-day benefits have been depleted for the year. This explains why Bestmed wasn't able to cover the full cost of the allergy blood test.
in addition, Bestmed covers the diagnosis, treatment and care costs of Prescribed Minimum Benefits (PMBs).
This includes the provision of diagnosis, treatment, and care costs for:
- A limited set of 271 conditions as specified in Annexure A of the Regulations to the Medical Schemes Act
- A list of 26 chronic conditions which are also referred to as the Chronic Disease List (CDL)
- An emergency medical condition such as any sudden and/or unexpected health condition that requires immediate medical treatment
It is important to note that Bestmed offers 11 different medical aid plans to cater to a variety of member needs and budgets. These plans may have varying coverage levels for out-of-hospital services, including pathology tests.
We sincerely apologize for any inconvenience this may cause. We understand the importance of having access to necessary tests for diagnosis and treatment.
We recommend reviewing your plan brochure or contacting our member support team to discuss your specific coverage details and explore options that might better suit your healthcare needs.
I trust you will find this feedback useful. If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us on ***. Your wellbeing, as a valued client of the Scheme, is important to all of us at Bestmed.
With Kind Regards,
Bestmed Medical Scheme
Bestmed Medical Scheme's reply04 Jul 2024, 09:27
Official
Dear Christopher,
Thank you for contacting Bestmed regarding your recent claim. We understand your frustration with the outcome of the claim, and we sincerely apologize for any inconvenience caused.
We've reviewed your claim and plan details and we'd like to clarify how out-of-hospital services are covered under your chosen Bestmed plan.
In this instance, both your annual savings and day-to-day benefits have been depleted for the year. This explains why Bestmed wasn't able to cover the full cost of the allergy blood test.
in addition, Bestmed covers the diagnosis, treatment and care costs of Prescribed Minimum Benefits (PMBs).
This includes the provision of diagnosis, treatment, and care costs for:
It is important to note that Bestmed offers 11 different medical aid plans to cater to a variety of member needs and budgets. These plans may have varying coverage levels for out-of-hospital services, including pathology tests.
We sincerely apologize for any inconvenience this may cause. We understand the importance of having access to necessary tests for diagnosis and treatment.
We recommend reviewing your plan brochure or contacting our member support team to discuss your specific coverage details and explore options that might better suit your healthcare needs.
I trust you will find this feedback useful. If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us on ***. Your wellbeing, as a valued client of the Scheme, is important to all of us at Bestmed.
With Kind Regards,
Bestmed Medical Scheme
Thank you for contacting Bestmed regarding your recent claim. We understand your frustration with the outcome of the claim, and we sincerely apologize for any inconvenience caused.
We've reviewed your claim and plan details and we'd like to clarify how out-of-hospital services are covered under your chosen Bestmed plan.
- Under your chosen Bestmed plan option, out-of-hospital services, including pathology tests like your allergy blood test, are initially paid from your annual medical savings account.
- Once the annual savings are depleted, coverage continues from your day-to-day benefit (High-Risk Benefit). This benefit covers basic services like pathology tests, consultations, and treatment, but up to a specific limit.
In this instance, both your annual savings and day-to-day benefits have been depleted for the year. This explains why Bestmed wasn't able to cover the full cost of the allergy blood test.
in addition, Bestmed covers the diagnosis, treatment and care costs of Prescribed Minimum Benefits (PMBs).
This includes the provision of diagnosis, treatment, and care costs for:
- A limited set of 271 conditions as specified in Annexure A of the Regulations to the Medical Schemes Act
- A list of 26 chronic conditions which are also referred to as the Chronic Disease List (CDL)
- An emergency medical condition such as any sudden and/or unexpected health condition that requires immediate medical treatment
It is important to note that Bestmed offers 11 different medical aid plans to cater to a variety of member needs and budgets. These plans may have varying coverage levels for out-of-hospital services, including pathology tests.
We sincerely apologize for any inconvenience this may cause. We understand the importance of having access to necessary tests for diagnosis and treatment.
We recommend reviewing your plan brochure or contacting our member support team to discuss your specific coverage details and explore options that might better suit your healthcare needs.
I trust you will find this feedback useful. If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us on ***. Your wellbeing, as a valued client of the Scheme, is important to all of us at Bestmed.
With Kind Regards,
Bestmed Medical Scheme
CK
Christopher K's updateReviewer Update
05 Jul 2024, 16:25Thank you for confirming that Bestmed does not care about their customers. I am sick and now I cannot get help because I do not have the funds to pay for diagnosis. What is important to you is to get the monthly contribution. You do not care what is happening to your customers. You are not interested on the wellbeing of your customers.
CK
Christopher K's update05 Jul 2024, 16:25
Reviewer Update
Thank you for confirming that Bestmed does not care about their customers. I am sick and now I cannot get help because I do not have the funds to pay for diagnosis. What is important to you is to get the monthly contribution. You do not care what is happening to your customers. You are not interested on the wellbeing of your customers.
Bestmed Medical Scheme's replyOfficial
09 Jul 2024, 13:18Dear Christopher,
We understand your frustration regarding the partial coverage for your allergy blood test, especially while you're feeling unwell. We apologize that the previous explanation didn't alleviate your concerns.
Bestmed truly cares for our members' well-being within the scheme protocols and scheme rules which are in place to ensure the scheme can take care of all members in the best possible way.
We appreciate your understanding . If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us.
Sincerely,The Bestmed Team
We understand your frustration regarding the partial coverage for your allergy blood test, especially while you're feeling unwell. We apologize that the previous explanation didn't alleviate your concerns.
Bestmed truly cares for our members' well-being within the scheme protocols and scheme rules which are in place to ensure the scheme can take care of all members in the best possible way.
We appreciate your understanding . If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us.
Sincerely,The Bestmed Team
Bestmed Medical Scheme's reply09 Jul 2024, 13:18
Official
Dear Christopher,
We understand your frustration regarding the partial coverage for your allergy blood test, especially while you're feeling unwell. We apologize that the previous explanation didn't alleviate your concerns.
Bestmed truly cares for our members' well-being within the scheme protocols and scheme rules which are in place to ensure the scheme can take care of all members in the best possible way.
We appreciate your understanding . If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us.
Sincerely,The Bestmed Team
We understand your frustration regarding the partial coverage for your allergy blood test, especially while you're feeling unwell. We apologize that the previous explanation didn't alleviate your concerns.
Bestmed truly cares for our members' well-being within the scheme protocols and scheme rules which are in place to ensure the scheme can take care of all members in the best possible way.
We appreciate your understanding . If, however, you need more information, or support from our Client Relations Communication Team, please do not hesitate to contact us.
Sincerely,The Bestmed Team