EB
Edith B
1 reviews | Active since Sept 2020
02 Aug 2023, 18:41
No hospital authorisation yet all details provided
I provided all required details for my mom to do her CT SCAN as she is admitted in hospital but bestmed won’t even acknowledge the emails we have sent through, now my mom has to be discharged without even knowing the extent of the damage on her body. I guess a person’s life doesn’t matter when it comes to this medical aid.
Helpful (0)
Replies (15)0
Replies (15)
Bestmed Medical Scheme's replyOfficial
03 Aug 2023, 10:01Dear Edith,
Kindly note the request for authorisation is pending and the following information is required to refer and finalise the request for authorisation:
• We require a clinical report from the admitting doctor with any supporting test results for review;
• A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.
This information is requested in relation to the Bestmed Managed Care admission protocol for members with less than 12 months membership with the scheme.
Regards
Katlego Sithole
Kindly note the request for authorisation is pending and the following information is required to refer and finalise the request for authorisation:
• We require a clinical report from the admitting doctor with any supporting test results for review;
• A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.
This information is requested in relation to the Bestmed Managed Care admission protocol for members with less than 12 months membership with the scheme.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply03 Aug 2023, 10:01
Official
Dear Edith,
Kindly note the request for authorisation is pending and the following information is required to refer and finalise the request for authorisation:
• We require a clinical report from the admitting doctor with any supporting test results for review;
• A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.
This information is requested in relation to the Bestmed Managed Care admission protocol for members with less than 12 months membership with the scheme.
Regards
Katlego Sithole
Kindly note the request for authorisation is pending and the following information is required to refer and finalise the request for authorisation:
• We require a clinical report from the admitting doctor with any supporting test results for review;
• A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.
This information is requested in relation to the Bestmed Managed Care admission protocol for members with less than 12 months membership with the scheme.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
03 Aug 2023, 11:02Hi Katlego,
Did they inform you that I already submitted the ff on Monday to Bianca?
“A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.“
The Dr also provided the gastroscope report but I guess that’s not sufficient.
Your response shows that you just didn’t bother getting the latest response .
Did they inform you that I already submitted the ff on Monday to Bianca?
“A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.“
The Dr also provided the gastroscope report but I guess that’s not sufficient.
Your response shows that you just didn’t bother getting the latest response .
EB
Edith B's update03 Aug 2023, 11:02
Reviewer Update
Hi Katlego,
Did they inform you that I already submitted the ff on Monday to Bianca?
“A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.“
The Dr also provided the gastroscope report but I guess that’s not sufficient.
Your response shows that you just didn’t bother getting the latest response .
Did they inform you that I already submitted the ff on Monday to Bianca?
“A letter from the patient indicating when the symptoms first started; the duration thereof and if any previous treatment was sought (including over-the-counter medication)
• A 12-month general practitioner account statement from the member's attending general practitioner for the past 12 months prior to joining the scheme indicating: ICD-10 coding; service dates and treatment prescribed for each visit to the practice, including but not limited the current diagnosis for which authorisation is being requested for.“
The Dr also provided the gastroscope report but I guess that’s not sufficient.
Your response shows that you just didn’t bother getting the latest response .
Bestmed Medical Scheme's replyOfficial
03 Aug 2023, 11:47Dear Edith,
I have escalated your complaint to the Hospital Benefit Management Team Leaders for urgent investigation of the email received and finalization of the authorization.
We sincerely apologize for the inconvenience caused.
Regards
Katlego Sithole
I have escalated your complaint to the Hospital Benefit Management Team Leaders for urgent investigation of the email received and finalization of the authorization.
We sincerely apologize for the inconvenience caused.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply03 Aug 2023, 11:47
Official
Dear Edith,
I have escalated your complaint to the Hospital Benefit Management Team Leaders for urgent investigation of the email received and finalization of the authorization.
We sincerely apologize for the inconvenience caused.
Regards
Katlego Sithole
I have escalated your complaint to the Hospital Benefit Management Team Leaders for urgent investigation of the email received and finalization of the authorization.
We sincerely apologize for the inconvenience caused.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
07 Aug 2023, 10:25Hi Katlego, when will I receive feedback? I sent through everything that was required including the clinical report from the doctor on Thursday evening. What’s gonna be the TAT for this query?
EB
Edith B's update07 Aug 2023, 10:25
Reviewer Update
Hi Katlego, when will I receive feedback? I sent through everything that was required including the clinical report from the doctor on Thursday evening. What’s gonna be the TAT for this query?
Bestmed Medical Scheme's replyOfficial
07 Aug 2023, 11:11 Dear Edith,
Feedback from the Hospital Hospital Benefit Management Team Leader was as follows: we only received information from November last year and we are waiting for the current clinical information to review the case accordingly.
Regards
Katlego Sithole
Feedback from the Hospital Hospital Benefit Management Team Leader was as follows: we only received information from November last year and we are waiting for the current clinical information to review the case accordingly.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply07 Aug 2023, 11:11
Official
Dear Edith,
Feedback from the Hospital Hospital Benefit Management Team Leader was as follows: we only received information from November last year and we are waiting for the current clinical information to review the case accordingly.
Regards
Katlego Sithole
Feedback from the Hospital Hospital Benefit Management Team Leader was as follows: we only received information from November last year and we are waiting for the current clinical information to review the case accordingly.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
07 Aug 2023, 11:14Hi Katlego ,
The current clinical information was sent through to Bianca Beukes on Thursday at 9pm.
I called on Friday to follow up and there was no one to provide feedback. Where should we send through the documentation as it seems it might take ages to receive feedback as you can’t get them on time.
Regards,
Thembi
The current clinical information was sent through to Bianca Beukes on Thursday at 9pm.
I called on Friday to follow up and there was no one to provide feedback. Where should we send through the documentation as it seems it might take ages to receive feedback as you can’t get them on time.
Regards,
Thembi
EB
Edith B's update07 Aug 2023, 11:14
Reviewer Update
Hi Katlego ,
The current clinical information was sent through to Bianca Beukes on Thursday at 9pm.
I called on Friday to follow up and there was no one to provide feedback. Where should we send through the documentation as it seems it might take ages to receive feedback as you can’t get them on time.
Regards,
Thembi
The current clinical information was sent through to Bianca Beukes on Thursday at 9pm.
I called on Friday to follow up and there was no one to provide feedback. Where should we send through the documentation as it seems it might take ages to receive feedback as you can’t get them on time.
Regards,
Thembi
Bestmed Medical Scheme's replyOfficial
07 Aug 2023, 11:59Hi Thembi,
I have forwarded your message to the Team Lader for urgent assistance as they maintain that the information received is not sufficient.
Regards
Katlego Sithole
I have forwarded your message to the Team Lader for urgent assistance as they maintain that the information received is not sufficient.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply07 Aug 2023, 11:59
Official
Hi Thembi,
I have forwarded your message to the Team Lader for urgent assistance as they maintain that the information received is not sufficient.
Regards
Katlego Sithole
I have forwarded your message to the Team Lader for urgent assistance as they maintain that the information received is not sufficient.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
07 Aug 2023, 12:28Hi Katlego,
Can we be precise about what exactly is missing! Was there any communication sent through regarding what’s outstanding? I’m convinced BestMed is a **** because I have to follow up yet the response do not actually answer anything.
If you guys don’t want to pay for my mom’s hospitalisation, kindly please say so so that I know she doesn’t have medical cover from you. We pay premiums without issues, the least we should get is efficient service and response. I’m gonna call the authorisation department and enquire as it’s clear that communication from Bestmed is not a priority to its clients.
Can we be precise about what exactly is missing! Was there any communication sent through regarding what’s outstanding? I’m convinced BestMed is a **** because I have to follow up yet the response do not actually answer anything.
If you guys don’t want to pay for my mom’s hospitalisation, kindly please say so so that I know she doesn’t have medical cover from you. We pay premiums without issues, the least we should get is efficient service and response. I’m gonna call the authorisation department and enquire as it’s clear that communication from Bestmed is not a priority to its clients.
EB
Edith B's update07 Aug 2023, 12:28
Reviewer Update
Hi Katlego,
Can we be precise about what exactly is missing! Was there any communication sent through regarding what’s outstanding? I’m convinced BestMed is a **** because I have to follow up yet the response do not actually answer anything.
If you guys don’t want to pay for my mom’s hospitalisation, kindly please say so so that I know she doesn’t have medical cover from you. We pay premiums without issues, the least we should get is efficient service and response. I’m gonna call the authorisation department and enquire as it’s clear that communication from Bestmed is not a priority to its clients.
Can we be precise about what exactly is missing! Was there any communication sent through regarding what’s outstanding? I’m convinced BestMed is a **** because I have to follow up yet the response do not actually answer anything.
If you guys don’t want to pay for my mom’s hospitalisation, kindly please say so so that I know she doesn’t have medical cover from you. We pay premiums without issues, the least we should get is efficient service and response. I’m gonna call the authorisation department and enquire as it’s clear that communication from Bestmed is not a priority to its clients.
EB
Edith B's updateReviewer Update
07 Aug 2023, 17:40I’ve obtained authorisation, thank you for assisting.
EB
Edith B's update07 Aug 2023, 17:40
Reviewer Update
I’ve obtained authorisation, thank you for assisting.
EB
Edith B's updateReviewer Update
08 Aug 2023, 10:39So yesterday you guys approved the authorisation then today it is pending! What the **** is this? Yesterday the approval was to silence me or what?
EB
Edith B's update08 Aug 2023, 10:39
Reviewer Update
So yesterday you guys approved the authorisation then today it is pending! What the **** is this? Yesterday the approval was to silence me or what?
Bestmed Medical Scheme's replyOfficial
08 Aug 2023, 11:35Dear Edith,
For Bestmed to determine whether you will be exposed to any underwriting, please provide full details of your previous membership.
Underwriting may be a 3-month general waiting period, a 12-month exclusion of pre-existing conditions, a late joiner penalty, or a combination of any of these.
It is subject to an assessment done by Bestmed’s underwriting department, and it will be communicated to you in writing.
Kindly note that any conditions treated within the first 12 months of membership may be monitored.
The case has been pended for request of documents in relation to the condition for admission to investigate if the condition is not pre-existing before the member joined the scheme.
Regards
Katlego Sithole
For Bestmed to determine whether you will be exposed to any underwriting, please provide full details of your previous membership.
Underwriting may be a 3-month general waiting period, a 12-month exclusion of pre-existing conditions, a late joiner penalty, or a combination of any of these.
It is subject to an assessment done by Bestmed’s underwriting department, and it will be communicated to you in writing.
Kindly note that any conditions treated within the first 12 months of membership may be monitored.
The case has been pended for request of documents in relation to the condition for admission to investigate if the condition is not pre-existing before the member joined the scheme.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply08 Aug 2023, 11:35
Official
Dear Edith,
For Bestmed to determine whether you will be exposed to any underwriting, please provide full details of your previous membership.
Underwriting may be a 3-month general waiting period, a 12-month exclusion of pre-existing conditions, a late joiner penalty, or a combination of any of these.
It is subject to an assessment done by Bestmed’s underwriting department, and it will be communicated to you in writing.
Kindly note that any conditions treated within the first 12 months of membership may be monitored.
The case has been pended for request of documents in relation to the condition for admission to investigate if the condition is not pre-existing before the member joined the scheme.
Regards
Katlego Sithole
For Bestmed to determine whether you will be exposed to any underwriting, please provide full details of your previous membership.
Underwriting may be a 3-month general waiting period, a 12-month exclusion of pre-existing conditions, a late joiner penalty, or a combination of any of these.
It is subject to an assessment done by Bestmed’s underwriting department, and it will be communicated to you in writing.
Kindly note that any conditions treated within the first 12 months of membership may be monitored.
The case has been pended for request of documents in relation to the condition for admission to investigate if the condition is not pre-existing before the member joined the scheme.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
08 Aug 2023, 12:00But my mom doesn’t have this new illness you are mentioning even.
EB
Edith B's update08 Aug 2023, 12:00
Reviewer Update
But my mom doesn’t have this new illness you are mentioning even.
EB
Edith B's updateReviewer Update
08 Aug 2023, 12:01And we have already provided all the information regarding her previous illnesses so I don’t know where I must go to further dig up or create doctors documentation. I’m really confused as we provided all we had
EB
Edith B's update08 Aug 2023, 12:01
Reviewer Update
And we have already provided all the information regarding her previous illnesses so I don’t know where I must go to further dig up or create doctors documentation. I’m really confused as we provided all we had
Bestmed Medical Scheme's replyOfficial
08 Aug 2023, 12:56Hi Edith,
I have communicated your response with the Team Leader for urgent assistance.
They should be able to call and explain the situation.
Regards
Katlego Sithole
I have communicated your response with the Team Leader for urgent assistance.
They should be able to call and explain the situation.
Regards
Katlego Sithole
Bestmed Medical Scheme's reply08 Aug 2023, 12:56
Official
Hi Edith,
I have communicated your response with the Team Leader for urgent assistance.
They should be able to call and explain the situation.
Regards
Katlego Sithole
I have communicated your response with the Team Leader for urgent assistance.
They should be able to call and explain the situation.
Regards
Katlego Sithole
EB
Edith B's updateReviewer Update
08 Aug 2023, 12:58Thanks I will await the call
EB
Edith B's update08 Aug 2023, 12:58
Reviewer Update
Thanks I will await the call