EK
Edwin K

1 reviews | Active since Nov 2019

20 Dec 2024, 08:46

Bestmed service non existent

Morning, My wife was diagnosed with diabetes which is paid under the PMB accompanied with a treatment plan. The treatment plan includes to see physician, dietitian and various other Doctors. The dietitian seen 2nd of December claim denied. On the 3rd of December I send an email enquiring to why ticket number received back E3D0C4F677300, stated they will come back within 24-72 hours. On the 11th I asked again still no answer. I phoned this morning spoke to 2 consultants and 1 consultant working in chronic department. First of all the first consultant stated they had a influx of mails, since the 3r I had no answer back form them shocking and a lame excuse. Then the consultant send the incorrect treatment plan to obtain the correct code for the dietitian to use. The gentleman at the chronic department gave me 3 codes, I asked which one the dietitian must use, he cant say, surely with diabetes 1 there is a certain code. The frustration here and it is not the first time this has happened no reply on your mails, when speaking to the consultants less helpful and clearly not properly trained. Paying a premium for what to get told they have to much emails, then clearly there business model and strategy not working. My member ship number . We will now have to guess with the dietician which code to be used. Shocking service.

0
Replies (5)
EK
Edwin K's update21 Dec 2024, 08:51
Reviewer Update
Morning. I do not agree with your answer. The treatment plan has been cancelled by your self's I spoke to Thaba at your client services yesterday. The diagnosis was changed from diabetes 2 to diabetes 2. You as the medical aid never changed the diagnosis nor the treatment plan. Please explain to me how does a treatment plan authorization stop? Lucky in the chronic department has been given me the run around since yesterday. Your systems are not updated and is causing issues with a patient diagnosed with a PMB, if this is not resolved by Monday I will report you to the Medical Counsil with all relevant emails, dates phoned etc. You cancelled the auth number from diabetes 2 and never changed it to Diabetes 1
EK
Edwin K's update23 Dec 2024, 07:58
Reviewer Update
Bestmed the diagnosis was changed from 2 to 1. Your consultants stated via email the plan and codes stay the same. Clearly you have no view or oversight on your own communications
EK
Edwin K's update24 Dec 2024, 09:58
Reviewer Update
Morning Bestmed

You still not resolved the issue. The treatment plan received from Lemay Erasmus still indicates Diabetes 2 and not Diabetes 1. In the body of your mail, it states Diabetes 1. The medication approved is also incorrect as the medication approved is Fiasp and Tresiba. If you did some more investigation, that is what has been approved via a script from Dr A Murphy. Clearly Bestmed has no clue to what is on their systems. I need this resolved and the Dietician accounts, which form part of the treatment plan. If not resolved by close of business Friday 27/12/2024 I will refer the matter to the medical council, with all proof of what I have said. The Fiasp and Tresiba has already been done if you looked onto the claim statements which clearly, you are not looking at all systems and information available. The medication in your email reply to me is under Diabetes 2 diagnosis, before 1 was diagnosed.
Bestmed Medical Scheme
Bestmed Medical Scheme's reply27 Dec 2024, 14:18
Official
Dear Mr. Kaufmann,

We have referred your case to our Prescribed Minimum Benefits (PMB) department for assistance in finalizing your treatment plan.
 
Once the treatment plan is finalized, we will be able to review the dietician claims from the chronic benefit perspective.
 
We will provide you with an update and feedback on the claims once the review is completed.
 
In the meantime, please do not hesitate to contact us if you have any further questions.

Regards
KS
EK
Edwin K's update28 Dec 2024, 10:00
Reviewer Update
Morning. Yet again excuses. On the 1st treatment plan the diatician included. Surely with any type of diabetes this should be included in the treatment pla. You as a organization have no clue what is going on. I will refer the matter now to the medical schemes counsil