EK
Elijah K
1 reviews | Active since May 2021
18 Jul 2022, 12:04
**** Service Again
What a **** service from these guys yet again. Everyone on my medical aid cover has completed their waiting period. Now they telling me one of them can not be admitted and there's actually a 12 month additional waiting period!!!!!!
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Bestmed Medical Scheme's replyOfficial
18 Jul 2022, 17:04Good day Mr Kgoso
Although you were registered as a member of Bestmed on 1 January 2022, coming over from the Nedgroup Medical Scheme without any underwriting applicable, you only registered your dependent, Remofilwe Kgoso with effect from 1 April 2022. As the registration took place more than 90 days after your transfer from the Nedgroup Medical Scheme, Mrs Kgoso was subject to full underwriting asd per the Rules of the Scheme.
The certificate of membership issued on 1 April 2022 indicated that a 3-month general waiting period app**** for all medical services, including PMB conditions. As full underwriting applies, Mrs Kgoso is however, also monitored for the first 12 months of membership of the Scheme for any possible pre-existing sickness condition. A request for pre-authorisation for surgery for ovarian cysts and/or endometriosis would definitely constitute a possible pre-existing sickness condition as was explained to you by our Hospital Benefit Management agent on 18 July 2022.
Kindly do note, that Bestmed is not refusing pre-authorisation at this stage. Authorisation is pending receipt of the required documentation upon receipt of which consideration will be given towards the pre-authorisation request.
With kind regards.
Marlene Hanekom
Although you were registered as a member of Bestmed on 1 January 2022, coming over from the Nedgroup Medical Scheme without any underwriting applicable, you only registered your dependent, Remofilwe Kgoso with effect from 1 April 2022. As the registration took place more than 90 days after your transfer from the Nedgroup Medical Scheme, Mrs Kgoso was subject to full underwriting asd per the Rules of the Scheme.
The certificate of membership issued on 1 April 2022 indicated that a 3-month general waiting period app**** for all medical services, including PMB conditions. As full underwriting applies, Mrs Kgoso is however, also monitored for the first 12 months of membership of the Scheme for any possible pre-existing sickness condition. A request for pre-authorisation for surgery for ovarian cysts and/or endometriosis would definitely constitute a possible pre-existing sickness condition as was explained to you by our Hospital Benefit Management agent on 18 July 2022.
Kindly do note, that Bestmed is not refusing pre-authorisation at this stage. Authorisation is pending receipt of the required documentation upon receipt of which consideration will be given towards the pre-authorisation request.
With kind regards.
Marlene Hanekom
Bestmed Medical Scheme's reply18 Jul 2022, 17:04
Official
Good day Mr Kgoso
Although you were registered as a member of Bestmed on 1 January 2022, coming over from the Nedgroup Medical Scheme without any underwriting applicable, you only registered your dependent, Remofilwe Kgoso with effect from 1 April 2022. As the registration took place more than 90 days after your transfer from the Nedgroup Medical Scheme, Mrs Kgoso was subject to full underwriting asd per the Rules of the Scheme.
The certificate of membership issued on 1 April 2022 indicated that a 3-month general waiting period app**** for all medical services, including PMB conditions. As full underwriting applies, Mrs Kgoso is however, also monitored for the first 12 months of membership of the Scheme for any possible pre-existing sickness condition. A request for pre-authorisation for surgery for ovarian cysts and/or endometriosis would definitely constitute a possible pre-existing sickness condition as was explained to you by our Hospital Benefit Management agent on 18 July 2022.
Kindly do note, that Bestmed is not refusing pre-authorisation at this stage. Authorisation is pending receipt of the required documentation upon receipt of which consideration will be given towards the pre-authorisation request.
With kind regards.
Marlene Hanekom
Although you were registered as a member of Bestmed on 1 January 2022, coming over from the Nedgroup Medical Scheme without any underwriting applicable, you only registered your dependent, Remofilwe Kgoso with effect from 1 April 2022. As the registration took place more than 90 days after your transfer from the Nedgroup Medical Scheme, Mrs Kgoso was subject to full underwriting asd per the Rules of the Scheme.
The certificate of membership issued on 1 April 2022 indicated that a 3-month general waiting period app**** for all medical services, including PMB conditions. As full underwriting applies, Mrs Kgoso is however, also monitored for the first 12 months of membership of the Scheme for any possible pre-existing sickness condition. A request for pre-authorisation for surgery for ovarian cysts and/or endometriosis would definitely constitute a possible pre-existing sickness condition as was explained to you by our Hospital Benefit Management agent on 18 July 2022.
Kindly do note, that Bestmed is not refusing pre-authorisation at this stage. Authorisation is pending receipt of the required documentation upon receipt of which consideration will be given towards the pre-authorisation request.
With kind regards.
Marlene Hanekom