vM
vuledzani M
1 reviews | Active since Oct 2012
25 Sept 2023, 09:51
Pathetic ********* Service
I am having serious problems with bestmed. I went to ER on their DSP hospital. They paid all the claims using my MSA. How possible is that My daughter went to ER at the same hospital. They are refusing to pay the plastic surgeon under PMB for the treatment she received for the 2 weeks in ICU. The shortfall is almost 100k. My husband also went for an authorized surgery. They never paid the claims in full. We even got listened on transunion for default. I am just tired of Bestmed at this point.
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Replies (5)0
Replies (5)
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 10:54Dear Vuledzani Mudau
Kindly be informed that ER/Casualty claims are covered from savings as they are not admissions to the hospital. We can only pay from scheme benefits if authorisation is granted for admission.
The application for PMB for the plastic surgeon's account was pending due to the awaited radiology report. We have now received the report, and our clinical committee is reviewing the application. Once the review is complete, we will provide you with feedback.
The short payment of Dr. Dybala's account for Mr. Sigama's admission is because he claimed above the scheme rate. We couldn't review a claim for PMB as the primary diagnosis code (ICD 10 code) is non-PMB.
Regards
Nondumiso Letsoalo
Kindly be informed that ER/Casualty claims are covered from savings as they are not admissions to the hospital. We can only pay from scheme benefits if authorisation is granted for admission.
The application for PMB for the plastic surgeon's account was pending due to the awaited radiology report. We have now received the report, and our clinical committee is reviewing the application. Once the review is complete, we will provide you with feedback.
The short payment of Dr. Dybala's account for Mr. Sigama's admission is because he claimed above the scheme rate. We couldn't review a claim for PMB as the primary diagnosis code (ICD 10 code) is non-PMB.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 10:54
Official
Dear Vuledzani Mudau
Kindly be informed that ER/Casualty claims are covered from savings as they are not admissions to the hospital. We can only pay from scheme benefits if authorisation is granted for admission.
The application for PMB for the plastic surgeon's account was pending due to the awaited radiology report. We have now received the report, and our clinical committee is reviewing the application. Once the review is complete, we will provide you with feedback.
The short payment of Dr. Dybala's account for Mr. Sigama's admission is because he claimed above the scheme rate. We couldn't review a claim for PMB as the primary diagnosis code (ICD 10 code) is non-PMB.
Regards
Nondumiso Letsoalo
Kindly be informed that ER/Casualty claims are covered from savings as they are not admissions to the hospital. We can only pay from scheme benefits if authorisation is granted for admission.
The application for PMB for the plastic surgeon's account was pending due to the awaited radiology report. We have now received the report, and our clinical committee is reviewing the application. Once the review is complete, we will provide you with feedback.
The short payment of Dr. Dybala's account for Mr. Sigama's admission is because he claimed above the scheme rate. We couldn't review a claim for PMB as the primary diagnosis code (ICD 10 code) is non-PMB.
Regards
Nondumiso Letsoalo
vM
vuledzani M's updateReviewer Update
26 Sept 2023, 16:44Good day
Your response is not correct
My daughters bill was rejected again last week. You always claim that the doctor is not providing you information. I have to call you and the doctor like I am doing your job. You are making this difficult so you don't pay
The anesthetic has also sent his claims and you rejected them saying it's 4 months after treatment, whereas he has been submitting since the treatment.
Mr Sigama's account that has not been paid is the hospital bill not Dr Dybalas bill.
My daughters hospital stay has also not been paid in full
To my ER issue, who was supposed to get authorization because I was sick and couldn't do that
Your response is not correct
My daughters bill was rejected again last week. You always claim that the doctor is not providing you information. I have to call you and the doctor like I am doing your job. You are making this difficult so you don't pay
The anesthetic has also sent his claims and you rejected them saying it's 4 months after treatment, whereas he has been submitting since the treatment.
Mr Sigama's account that has not been paid is the hospital bill not Dr Dybalas bill.
My daughters hospital stay has also not been paid in full
To my ER issue, who was supposed to get authorization because I was sick and couldn't do that
vM
vuledzani M's update26 Sept 2023, 16:44
Reviewer Update
Good day
Your response is not correct
My daughters bill was rejected again last week. You always claim that the doctor is not providing you information. I have to call you and the doctor like I am doing your job. You are making this difficult so you don't pay
The anesthetic has also sent his claims and you rejected them saying it's 4 months after treatment, whereas he has been submitting since the treatment.
Mr Sigama's account that has not been paid is the hospital bill not Dr Dybalas bill.
My daughters hospital stay has also not been paid in full
To my ER issue, who was supposed to get authorization because I was sick and couldn't do that
Your response is not correct
My daughters bill was rejected again last week. You always claim that the doctor is not providing you information. I have to call you and the doctor like I am doing your job. You are making this difficult so you don't pay
The anesthetic has also sent his claims and you rejected them saying it's 4 months after treatment, whereas he has been submitting since the treatment.
Mr Sigama's account that has not been paid is the hospital bill not Dr Dybalas bill.
My daughters hospital stay has also not been paid in full
To my ER issue, who was supposed to get authorization because I was sick and couldn't do that
Bestmed Medical Scheme's replyOfficial
27 Sept 2023, 08:16Dear Vuledzani Mudau
Please email us the details of the accounts you are complaining about so we can provide you with an efficient, accurate answer. The email address is ***.
Regards
Nondumiso Letsoalo
Please email us the details of the accounts you are complaining about so we can provide you with an efficient, accurate answer. The email address is ***.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply27 Sept 2023, 08:16
Official
Dear Vuledzani Mudau
Please email us the details of the accounts you are complaining about so we can provide you with an efficient, accurate answer. The email address is ***.
Regards
Nondumiso Letsoalo
Please email us the details of the accounts you are complaining about so we can provide you with an efficient, accurate answer. The email address is ***.
Regards
Nondumiso Letsoalo
vM
vuledzani M's updateReviewer Update
29 Sept 2023, 13:00Good day
Your email address is hidden
Please send it to me
Your email address is hidden
Please send it to me
vM
vuledzani M's update29 Sept 2023, 13:00
Reviewer Update
Good day
Your email address is hidden
Please send it to me
Your email address is hidden
Please send it to me
Bestmed Medical Scheme's replyOfficial
02 Oct 2023, 16:39Dear Vuledzani Mudau
I have emailed you the address for the escalations department.
Regards
Nondumiso Letsoalo
I have emailed you the address for the escalations department.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply02 Oct 2023, 16:39
Official
Dear Vuledzani Mudau
I have emailed you the address for the escalations department.
Regards
Nondumiso Letsoalo
I have emailed you the address for the escalations department.
Regards
Nondumiso Letsoalo