GK
Gcina K
1 reviews | Active since Oct 2017
07 Apr 2025, 16:32
Misleading Information, Rejected Claim, and Zero Help from BestMed
I switched to BestMed from another medical aid, and was clearly told that my benefits would be active immediately since I was already on a medical aid — meaning no waiting period.
A few months ago, I had to take my toddler to the ER at Netcare Olivedale due to severe stomach pain and constipation. She was treated by ERConsultants and had to get an x-ray. I submitted the claim through BestMed, only to later be told that it was rejected due to a supposed “non-disclosure” — something I was never made aware of, especially not for a basic stomach bug in a toddler.
Now, I’m being held liable for the medical bills from Netcare, ERConsultants, and radiology — all because BestMed claims I should have disclosed this as a "pre-existing condition"? Really?
Since then, I’ve called countless times and spoken to multiple consultants, and not one has been able to give me a proper explanation or resolution. No accountability, no clarity — just being sent in circles.
I feel completely misled, unsupported, and disappointed. This is not the service I was promised when I joined BestMed.
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Replies (3)
Bestmed Medical Scheme's replyOfficial
08 Apr 2025, 09:40Dear Gcina Kgogo
Thank you for reaching out and sharing your concerns with us. We sincerely apologize for any inconvenience you have experienced.
Please note that we have responded to your query via your registered email address.
Thank you for your understanding and for the opportunity to address your issues
Best regards
GM
GM
Bestmed Medical Scheme's reply08 Apr 2025, 09:40
Official
Dear Gcina Kgogo
Thank you for reaching out and sharing your concerns with us. We sincerely apologize for any inconvenience you have experienced.
Please note that we have responded to your query via your registered email address.
Thank you for your understanding and for the opportunity to address your issues
Best regards
GM
GM
GK
Gcina K's updateReviewer Update
09 Apr 2025, 14:32Thank you for your response.
While I appreciate the explanation provided, I must express my deep concern and disappointment regarding how this matter is being handled—particularly given the emotional toll it has taken on my child and family.
Firstly, the claims were rejected due to “possible non-disclosure of pre-existing conditions,” yet no clear indication has been given as to what condition you believe was not disclosed. This puts the burden entirely on me to prove a negative—requiring extensive paperwork, additional trauma to my child through repeated tests, and documentation I’ve already partially submitted (including a report from a treating doctor).
Secondly, expecting parents to:
- Subject a child to further blood tests,
- Revisit specialists for reports already issued,
- Write letters confirming the absence of a condition,
- And retrieve test results that could have been directly requested from the hospital by your team,
—feels unnecessarily bureaucratic and lacking in empathy, especially for a child’s emergency care. Furthermore, I joined Bestmed in good faith, added my family to the cover, and paid monthly premiums under the impression that in an emergency, my child would be taken care of. Yet I find myself being penalized for something that has not been clearly defined. I respectfully request:
- A clear explanation of what specific pre-existing condition is believed to have been undisclosed.
- A reconsideration of the claims based on the specialist report already provided.
- That your team liaise directly with Netcare Olivedale Hospital to obtain any additional medical records required, rather than placing that burden on me.
This process has already caused enough distress. I urge you to approach this with the humanity and fairness that medical aid schemes are expected to uphold. I look forward to your urgent and compassionate response. Kind regards, Gcina Kgogo
GK
Gcina K's update09 Apr 2025, 14:32
Reviewer Update
Thank you for your response.
While I appreciate the explanation provided, I must express my deep concern and disappointment regarding how this matter is being handled—particularly given the emotional toll it has taken on my child and family.
Firstly, the claims were rejected due to “possible non-disclosure of pre-existing conditions,” yet no clear indication has been given as to what condition you believe was not disclosed. This puts the burden entirely on me to prove a negative—requiring extensive paperwork, additional trauma to my child through repeated tests, and documentation I’ve already partially submitted (including a report from a treating doctor).
Secondly, expecting parents to:
- Subject a child to further blood tests,
- Revisit specialists for reports already issued,
- Write letters confirming the absence of a condition,
- And retrieve test results that could have been directly requested from the hospital by your team,
—feels unnecessarily bureaucratic and lacking in empathy, especially for a child’s emergency care. Furthermore, I joined Bestmed in good faith, added my family to the cover, and paid monthly premiums under the impression that in an emergency, my child would be taken care of. Yet I find myself being penalized for something that has not been clearly defined. I respectfully request:
- A clear explanation of what specific pre-existing condition is believed to have been undisclosed.
- A reconsideration of the claims based on the specialist report already provided.
- That your team liaise directly with Netcare Olivedale Hospital to obtain any additional medical records required, rather than placing that burden on me.
This process has already caused enough distress. I urge you to approach this with the humanity and fairness that medical aid schemes are expected to uphold. I look forward to your urgent and compassionate response. Kind regards, Gcina Kgogo
Bestmed Medical Scheme's replyOfficial
10 Apr 2025, 09:28Dear Gcina Kgogo
Thank you for your query. Please respond to the email that was sent to you, and our dedicated team will ensure that your concerns are addressed accordingly.
Best Regards
GM
GM
Bestmed Medical Scheme's reply10 Apr 2025, 09:28
Official
Dear Gcina Kgogo
Thank you for your query. Please respond to the email that was sent to you, and our dedicated team will ensure that your concerns are addressed accordingly.
Best Regards
GM
GM