Medical benefits changed without my knowledge

<p>Goodday,</p> <p> </p> <p> </p> <p>The day before my 6 week checkup (10-01-2017) I phoned my medical consultant (Juanita Pilon from Vital Consultants) to find out if I needed to get authorization for the Mirana, she said no I don’t need authorization Bestmed will pay it. This was the 3rd time I asked her, I moved to Bestmed end of July with a 3month waiting period especially for the immunization injections, the savings and the Mirena</p> <p>These were part of her sales pitch to me, twice at our EVN Africa Office in Polokwane. Both times she showed me the Bestmed Beat 2 pamphlet and email it to me as well. She( Juanita Pilon) told me I could go on the Network option as it is a bit cheaper and the ONLY difference is that I have to go to certain hospitals and she emailed me the list of hospitals on ( 4-07-2016).</p> <p> </p> <p>On 10-01-2017 I took my son for his 6 week Immunization Injections and on 7-02-2017 for his 10 week Immunization Injections (As on the pamphlet of 2016 and 2017, it shows that it is part of my benefits) but on 7-02-2017 they told me there are no funds and I had to pay R+-300. I did not understand what was going on?!! So I contacted Juanita Pilon so she could find out what was going on as I was still on maternity leave.</p> <p> </p> <p>On 16-02-2016 Juanita sent me my Savings breakdown. The following was taken off my SAVINGS!</p> <p> </p> <p>Real Health Pharmacy</p> <p>10/01/17 (Marcelle Inspuitings)</p> <p>Hexexim R486,18</p> <p>Prevenar R775,26 </p> <p>Rotarix R398,58 </p> <p> </p> <p>· 07/02/17 (Marcelle Inspuitings)</p> <p>Hexexim R486,18 </p> <p>Prevenar R775,26 </p> <p> </p> <p>Pretorius JD & Partners</p> <p>11/01/2017</p> <p>Merina Kit R873.76</p> <p> </p> <p>Du Buisonn KRA</p> <p>12/01/2017</p> <p>Papsmear R341.60</p> <p> </p> <p>I sent my quarries to Juanita. After several emails she told me she could not get hold of Bestmed/They are not getting back to her.</p> <p> </p> <p>On 9-03-2017 I phoned Bestmed myself and spoke to Veronique Ref. ********** 2. She told me that from 2017 the Immunization are no longer covered. I was shocked as it was the 1st I was hearing about this. I told her why on earth would I move to Bestmed late 2016 if this was taken away (as it was part of Juanita’s sales pitch to me) I told her I DID NOT receive an email, Phone Call, Letter or SMS stating there were any changes) Veronique told me there were emails sent out. I asked for proof as I did not receive anything. To this day I have not received any proof.</p> <p> </p> <p>On 25-03-2017 Sharon Geldenhuys rep**** to my query wherein she told me that the Immunizations were to be paid from savings as it is no longer a benefit in the 2017 plan.</p> <p> </p> <p> </p> <p>04-04-2017 I phoned Bestmed to speak to Sharon Geldenhuys, I was not allowed, so spoke to Marishian. Ref ********** 9. She told me letters were posted in November 2016 with the benefit changes.</p> <p>I told her I did not receive anything, ONLY my new Bestmed cards in January with my son as new beneficiary. Once again I asked why these things were going off my savings. She said I am on a Network option and a lot of the Beat 2 benefits are not given on the Network option. I said NO!!! Juanita told me the ONLY difference is that I can only go the certain hospitals and that was why she emailed me the list of hospitals on ( 4-07-2016)</p> <p> </p> <p>The 2017 Beat 2 pamphlet I have still shows the Immunizations are covered under preventative benefits (Page 5), as well as one Papsmeer (24 months) and 1 Mirena (every 60 months)</p> <p> </p> <p>I have no savings lest in my SAVINGS, and the winter has started. I would of never taken my son for the Immunizations if I knew it was coming out of my savings, as well as never inserted the Mirena.</p> <p>I am not allowed to move my option (only allowed in December/January) and can also mot move to another medical aid as I will have to pay back the savings used.</p> <p> </p> <p>This is totally unacceptable!!</p> <p> </p> <p>I feel these deductions must be paid back into my savings and taken of the preventative benefits as stated on the pamphlet. As I was not made aware of the changes and my</p> <p>medical consultant (Juanita Pilon from Vital Consultants) neither.</p> <p>I will not take my son for the Immunizations on medical aid, I will go to the clinic, but the ones on 10-01-2017 & 07-02-2018 must be sorted out.</p> <p> </p> <p>I have various emails if you need any info please contact me. Please see email Ticket:E****D2586D10 Re. before point 6.3.11 she states that there was a mistake on the pamphlet and they were distributed before 2017’s benefits were finalized.</p> <p>This is their responsibility.</p>