PM
Philiswa M

1 reviews | Active since Feb 2023

02 Nov 2023, 12:24

Unsatisfied patience

I am so disappointed with my medical aid, I have been paying it since last year without claiming but now am in hospital sick but they cannot approve the CT scans needed by the hospital. I am sick, I am sick, I don't know where to go.. I am being discharge without any assistance 💔💔💔💔💔💔💔💔. If anything happen to me I will blame best med.

0
Replies (5)
Bestmed Medical Scheme
Bestmed Medical Scheme's reply02 Nov 2023, 13:09
Official
Dear Philiswa Mahamba

Please be advised that according to the scheme's protocols and funding guidelines, a CT scan for chronic headaches is covered under the out-of-hospital specialized radiology benefits, not the in-hospital benefits.

Tests and investigations, including MRI/CT imaging, are not routinely included in hospital admissions.

We have sent you correspondence regarding your admission to the hospital.

Regards
Nondumiso
PM
Philiswa M's update02 Nov 2023, 13:15
Reviewer Update
Best med requested a motivation letter from the doctor and we sent it and also requested the below information and was sent and you saying you have a long queue and you will review request on the 13th of October 2023. See the below

Dear Penelope
Mahamba and Providers

Please note the request for
authorisation has been loaded and remains pending for:

- Treatment plan.

- Clinical information (signs
and symptoms).

- Vital data on admission.

This information can be-mailed
to *** (mailto:***)
or telephonically advised on ***.

Kindly note in terms of the
scheme's funding guideline, we fund a maximum of 24 hours for headache/migraine
admissions. Should the member stay longer, the balance will unfortunately
be for the members' own account.

Extend in length of stay must
be updated clinically by the admitting facility. Should the received
information not validate the extended stay, the request will not be
updated.

Tests and investigations,
including MRI/CT imaging is not routinely included in the admission.
Approval and authorisations for investigations must be requested individually
for benefit approval

Functional prosthesis limit =
R31 000.00 member/year subject to availability (including bone cement).
This sub-limit will apply to implants, devices and items utilized during
procedures. The items or implants typically have a function within the body in
the area where they are being implanted.

Link that may assist you
regarding this admission:

https://www.bestmed.co.za/-/media/Project/bestmed/downloads/Medicine-and-Chronic/Precedex-Information.pdf

Member will be liable for the
shortfalls.

Yours sincerely

BESTMED MEDICAL SCHEME
Bestmed Medical Scheme
Bestmed Medical Scheme's reply03 Nov 2023, 08:33
Official
Dear  Philiswa Mahamba 

The hospital authorization was granted, and we have emailed you the authorization letter.

Regards
Nondumiso
PM
Philiswa M's update03 Nov 2023, 12:01
Reviewer Update
Good day

As per above email sent you have confirmed that letter is emailed to me but I have not receive any Auth letter.
Kindly advise

Regards
PP Mahamba
Bestmed Medical Scheme
Bestmed Medical Scheme's reply03 Nov 2023, 12:25
Official
Dear Philiswa Mahamba 

Please be aware that we have sent the letter to your work email address, as it is the address associated with your membership registration.

Regards
Nondumiso