Failure to Cover Hospital Admission (29 January 2025 – 5 February 2025, Cape Gate Hospital)

I was admitted to cape Gate hospital on 29 January 2025 through casualty due to excruciating pain radiating from my back down my left leg and toes. Casualty department conducted tests and ordered a MRI scan. The 20-minutes MRI scan was unbearable As I was to lie flat despite the severe pain. I was entirely dependent on hospital staff for assistance, as I Could not move without extreme discomfort and pain. Following the MRI the on-call clinician with orthopedic Specialist who recommended immediate admission from the casualty ward. The specialist determined that surgery was necessary and scheduled the procedure for Friday 31 January 2025 @ 13:00 which was cancelled due to a lack of response from Bestmed regarding authorization. Despite continuous administration of pain medication, I remained in serve pain through the whole weekend Awaiting authorisation the hospital notes will reflect the numerous times I cried out die to unbearable pain and discomfort. Additionally , Bestmed was aware of my pre-existing condition , rheumatoid arthritis [registered PMB] which further exacerbates my pain levels. Despite this there was no urgency or consideration in handling the case. Hospital auth was granted on 31 January 2025 and procedure was performed on 3 February 2025 On 3 February 2025 Bestmed pended the auth for my husband who was not hospitalized, no auth was requested for him Bestmed declined my entire authorization on 10 February of which was discharged on 5 February 2025.

CMS complaint have been logged 13/03/2025: