Disgusting service from Bestmed!

Absolutely disgusting service!!

I was diagnosed with a middle ear tumour in May 2023 which needed surgical removal. My ENT specialist in Port Elizabeth referred me to a top specialist in Somerset West as even though my ENT is a very well renowned and respected doctor, was not prepared to operate due to the complexity of the operation and the fact that the tumour was encasing the nerves. The specialist in Somerset West requested an MRI to plan for surgery as at this point they were still not able to determine what sort of tumour it was. Bestmed rejected the claim for the MRI and I had to pay nearly R17k out of my pocket. My ENT completed a PMB application and it was submitted to Bestmed in July. The PMB was only approved in December and valid until 31 December, I only received this correspondence after complaining about no response. I requested for Bestmed to refund the amount and they requested an invoice which I sent back to the escalations consultant who requested it and received no further response. After two more emails requesting feedback I received an email from a different consultant saying that they can’t process the claim as I have not submitted an invoice. During this period the claim was somehow processed firstly to my ENT who did not do the scan and then the service provider and rejected both times. I requested a refund not for the provider to be paid as I already paid them on 28 June 2023 which was the date of MRI. Still no refund after almost 7 months since the scan.

Bestmed also refused to pay for my surgeons bill in full leaving me with a shortfall of around R40k. I have had endless complaints and emails with them. It was stated that I never used the one doctor on their dsp list in Port Elizabeth.

I was specifically referred to Somerset West for a very specialised doctor to operate because of the complexity. Only after the histology came back from a biopsy taken during surgery was it discovered that I had a Neuroendocrine tumour of the middle ear which is extremely rare. A final online teams meeting was held with multiple Bestmed employees on Thursday 9 November 2023. It was stated that they will not pay my claim for the surgery and that I will receive correspondence on this by Wednesday of the next week which I can use to submit to the medical ombudsman as I said I will be doing this due to dissatisfaction. No correspondence was received, multiple emails were sent to all attendees of the meeting with not a single response to this day.

I have never had such terrible service from any service provider before especially during a terrible time of the diagnosis.