PB
Petrus B

1 reviews | Active since Feb 2018

27 May 2025, 20:09

Bestmed = WorstMed

I would like to ask Bestmed a few questions - since they are rarely available or are "too busy" to respond to emails and only respond to emails when they feel like they want to respond.

Yesterday, I visited the dentist due to a broken wisdom tooth, which now requires surgical removal. The dentist submitted a claim to Bestmed for R4100, but it was rejected. Bestmed claims that this in-hospital dental procedure is not covered by my BEAT 2 NETWORK plan.

Can Bestmed explain why I have a hospital plan that doesn’t cover in-hospital procedures, dental or otherwise? I pay R2600 every month (on time) and yet I receive virtually no real benefits.

Let me be clear about my situation: - I’m a type 1 diabetic. Bestmed covers insulin, but not test strips. - I suffer from depression, but my anti-depressants are not covered. - I require ADHD and sleep medication—also not covered.

So for R2600 a month, the only benefit I receive is insulin (which costs R700 over the counter). Where does the remaining R1900 go?

It raises the question: does Bestmed prioritize member well-being, or just collecting payments?

Please do not respond with the usual “you need to upgrade your plan” line; I will not accept that as a valid response. That’s not a solution; it’s an excuse.

And to be clear, I expect a public response to this message, not a private email. People deserve to see how Bestmed treats its members.

Even the healthcare professionals at the CDE (Centre for Diabetes and Endocrinology) refer to Bestmed as “WorstMed.” That alone says a lot.

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Replies (1)
Bestmed Medical Scheme
Bestmed Medical Scheme's reply30 May 2025, 10:06
Official
 
Dear Petrus Botes

Thank you for taking the time to share your experience with us. We sincerely regret to hear that you feel let down by Bestmed, and we understand the frustration and disappointment expressed in your message. 

We acknowledge your concerns regarding claim rejections and your perception of limited benefits, especially considering your chronic conditions. While your BEAT 2 Network plan provides cover for a broad range of healthcare needs, it unfortunately does not include cover for dental procedures performed in-hospital unless these qualify under Prescribed Minimum Benefits (PMBs) or children until and including 7 years of age and meet the criteria set by the Council for Medical Schemes. In this instance, the procedure you app**** for did not meet the PMB criteria, which is why it was not approved. 

We would also like to clarify that certain chronic medication, including some test strips, antidepressants, and ADHD treatments, may not be included on the formulary for your plan option. This can understandably be frustrating, especially when managing multiple chronic conditions. We are currently reviewing feedback like yours to explore ways to improve access and affordability, particularly for members living with chronic illnesses. 

Your monthly contributions go toward a pooled risk fund that enables the Scheme to pay for hospitalizations, chronic conditions listed on the Chronic Disease List (CDL), preventative care, and more — all depending on the chosen plan. We do our best to keep plan contributions sustainable while offering meaningful cover, but we acknowledge that this balance doesn't always meet every member's unique needs. 

We understand that you're not looking for a generic recommendation to upgrade your plan, but we also believe transparency is key. Different plan options are designed to cater to different levels of healthcare needs, and in some cases, a plan review may be a practical step toward accessing the benefits you require. 

We deeply value your feedback, and we apologize if you have experienced delays in communication. 

 Thank you again for sharing your concerns — your feedback is important to us and helps us improve our service. 

If you would like to escalate your complaint, please feel free to send an email to ***. One of our representatives will review your submission and assist you further. 

Best Regards 
GM