VJ
Vurushca J
1 reviews | Active since Jan 2019
03 May 2024, 11:12
Very annoyed
I joined Bestmed at the beginning of this year and after a long 3 month waiting period, I was finally able to go and get a new pair of glasses, however I was told that due the plan I am on the medical only covers a portion and the rest should be paid out of my pocket. I am on Beat3 Plus and it has an Optic Benefit, however this benefit does not cover any optic addons. I have enquired if the balance can be paid from the available savings and was told that it does not work that way. I can't be paying for medical aid and then be told by the same people that I cannot use my savings for something that is imperative. I have sent through the quote for the necessary authorization and the quote is only valid until the 08 May 2024. I need this to be finalized before so that I can get my glasses.
Helpful (0)
Replies (12)0
Replies (12)
Bestmed Medical Scheme's replyOfficial
03 May 2024, 14:00Dear Miss Johnson
We sincerely apologize for any dissatisfaction you may have experienced regarding the outcome of your optical benefits shortfall. Please be informed that we have responded to your query via the registered email address.
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply03 May 2024, 14:00
Official
Dear Miss Johnson
We sincerely apologize for any dissatisfaction you may have experienced regarding the outcome of your optical benefits shortfall. Please be informed that we have responded to your query via the registered email address.
Best Regards
Bestmed Medical Scheme
VJ
Vurushca J's updateReviewer Update
10 May 2024, 08:21Till today I am not happy with the service received from BestMed, you guys are literally looking for all the ways possible to not pay for things. Some of us pay for medical aid because we cannot afford to pay for things out of our pockets and yet we are being inconvenienced at every turn
VJ
Vurushca J's update10 May 2024, 08:21
Reviewer Update
Till today I am not happy with the service received from BestMed, you guys are literally looking for all the ways possible to not pay for things. Some of us pay for medical aid because we cannot afford to pay for things out of our pockets and yet we are being inconvenienced at every turn
Bestmed Medical Scheme's replyOfficial
10 May 2024, 08:29 Dear Miss Johnson
We sincerely apologize for any dissatisfaction you may have experienced with the service you received
To ensure that we fully understand and address your concerns, we kindly request that you provide us with the details of your complaint by sending an email *** .Your feedback is invaluable to us, and we are committed to resolving any issues you may have encountered promptly.
Kindly be informed that our team will be responding to your queries and correspondence exclusively via email.
Best Regards
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply10 May 2024, 08:29
Official
Dear Miss Johnson
We sincerely apologize for any dissatisfaction you may have experienced with the service you received
To ensure that we fully understand and address your concerns, we kindly request that you provide us with the details of your complaint by sending an email *** .Your feedback is invaluable to us, and we are committed to resolving any issues you may have encountered promptly.
Kindly be informed that our team will be responding to your queries and correspondence exclusively via email.
Best Regards
Best Regards
Bestmed Medical Scheme
VJ
Vurushca J's updateReviewer Update
10 May 2024, 09:02I have had a whole lot of back and forth via email with BestMed and even after all that back and forth I am still not happy.
VJ
Vurushca J's update10 May 2024, 09:02
Reviewer Update
I have had a whole lot of back and forth via email with BestMed and even after all that back and forth I am still not happy.
Bestmed Medical Scheme's replyOfficial
10 May 2024, 10:27Dear Vurushca,
Thank you for your email and for expressing your concerns regarding the coverage of optical extras under your Bestmed medical aid plan.
After reviewing your inquiry, we would like to clarify that optical extras have been a scheme exclusion for many years. While contact lenses and prescription glasses are often covered when prescribed by a healthcare professional, items such as contact lens solutions, mirrors, and other accessories are generally considered to be outside the scope of medical necessity. They are viewed as more cosmetic or convenience items rather than essential for health and wellness.
Unfortunately, based on the information provided, Bestmed is unable to assist with your complaint regarding the coverage of these items. We recommend that you approach the Council for Medical Schemes for further assistance and guidance regarding your concerns.
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply10 May 2024, 10:27
Official
Dear Vurushca,
Thank you for your email and for expressing your concerns regarding the coverage of optical extras under your Bestmed medical aid plan.
After reviewing your inquiry, we would like to clarify that optical extras have been a scheme exclusion for many years. While contact lenses and prescription glasses are often covered when prescribed by a healthcare professional, items such as contact lens solutions, mirrors, and other accessories are generally considered to be outside the scope of medical necessity. They are viewed as more cosmetic or convenience items rather than essential for health and wellness.
Unfortunately, based on the information provided, Bestmed is unable to assist with your complaint regarding the coverage of these items. We recommend that you approach the Council for Medical Schemes for further assistance and guidance regarding your concerns.
Best Regards
Bestmed Medical Scheme
VJ
Vurushca J's updateReviewer Update
10 May 2024, 10:39The fact that Bestmed is playing gatekeepers with our savings is not fair. I am paying a load of money for premiums just for you guys to tell me that MY savings are to be spent the way you guys want me to spend it. According to you, Bestmed, the extras I need on my glasses is not necessary, however for me it is a need, my eyes are very sensitive to the light and I have explained this many times.
Now, I would like for Bestmed to explain to how I'm supposed to be able to pay for these things considering that I am paying over R5000 every month.
Now, I would like for Bestmed to explain to how I'm supposed to be able to pay for these things considering that I am paying over R5000 every month.
VJ
Vurushca J's update10 May 2024, 10:39
Reviewer Update
The fact that Bestmed is playing gatekeepers with our savings is not fair. I am paying a load of money for premiums just for you guys to tell me that MY savings are to be spent the way you guys want me to spend it. According to you, Bestmed, the extras I need on my glasses is not necessary, however for me it is a need, my eyes are very sensitive to the light and I have explained this many times.
Now, I would like for Bestmed to explain to how I'm supposed to be able to pay for these things considering that I am paying over R5000 every month.
Now, I would like for Bestmed to explain to how I'm supposed to be able to pay for these things considering that I am paying over R5000 every month.
Bestmed Medical Scheme's replyOfficial
10 May 2024, 10:52Hi Vurushca,
As per the rules of the scheme (ANNEXURE B.4: 4.1.3) The PMSA (Personal Medical Savings Account) shall be used solely for medical expenses pertaining to the out-of-hospital benefits referred to in Annexures B.1 and B.2 of the registered Rules and shall be subject to the exclusions referred to in Annexure C of the registered Rules.
we regret to inform you that, the member will be liable for the service.
You are welcome to go get a copy of the scheme rules on: https://www.bestmed.co.za/about-bestmed/governance#!schemerules
As per the rules of the scheme (ANNEXURE B.4: 4.1.3) The PMSA (Personal Medical Savings Account) shall be used solely for medical expenses pertaining to the out-of-hospital benefits referred to in Annexures B.1 and B.2 of the registered Rules and shall be subject to the exclusions referred to in Annexure C of the registered Rules.
we regret to inform you that, the member will be liable for the service.
You are welcome to go get a copy of the scheme rules on: https://www.bestmed.co.za/about-bestmed/governance#!schemerules
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply10 May 2024, 10:52
Official
Hi Vurushca,
As per the rules of the scheme (ANNEXURE B.4: 4.1.3) The PMSA (Personal Medical Savings Account) shall be used solely for medical expenses pertaining to the out-of-hospital benefits referred to in Annexures B.1 and B.2 of the registered Rules and shall be subject to the exclusions referred to in Annexure C of the registered Rules.
we regret to inform you that, the member will be liable for the service.
You are welcome to go get a copy of the scheme rules on: https://www.bestmed.co.za/about-bestmed/governance#!schemerules
As per the rules of the scheme (ANNEXURE B.4: 4.1.3) The PMSA (Personal Medical Savings Account) shall be used solely for medical expenses pertaining to the out-of-hospital benefits referred to in Annexures B.1 and B.2 of the registered Rules and shall be subject to the exclusions referred to in Annexure C of the registered Rules.
we regret to inform you that, the member will be liable for the service.
You are welcome to go get a copy of the scheme rules on: https://www.bestmed.co.za/about-bestmed/governance#!schemerules
Best Regards
Bestmed Medical Scheme
VJ
Vurushca J's updateReviewer Update
10 May 2024, 10:59Can Bestmed please tell me how I am supposed to fund this service?
VJ
Vurushca J's update10 May 2024, 10:59
Reviewer Update
Can Bestmed please tell me how I am supposed to fund this service?
VJ
Vurushca J's updateReviewer Update
10 May 2024, 11:07ALSO, WHY AM I PAYING SO MUCH MONEY FOR SOMETHING THAT I CANNOT USE. THIS HAS BECOME A REAL INCONVENIENCE FOR ME
VJ
Vurushca J's update10 May 2024, 11:07
Reviewer Update
ALSO, WHY AM I PAYING SO MUCH MONEY FOR SOMETHING THAT I CANNOT USE. THIS HAS BECOME A REAL INCONVENIENCE FOR ME
Bestmed Medical Scheme's replyOfficial
10 May 2024, 13:57Hi Vurushca,
As previously confirmed, the member will be liable for the service/ This means that you will have to pay cash for services/items that are not part of scheme benefits.
The business of the Scheme is undertaking, in return for a premium or contribution, the liability associated with one or more of the following activities:
As previously confirmed, the member will be liable for the service/ This means that you will have to pay cash for services/items that are not part of scheme benefits.
The business of the Scheme is undertaking, in return for a premium or contribution, the liability associated with one or more of the following activities:
- Providing for the obtaining of any relevant health service;
- Granting assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; or
- Rendering a relevant health service, either by the medical scheme itself, or by any supplier or group or suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.
The benefits you pay are solely for medical expenses and are subject to the exclusions referred to in Annexure C of the registered Rules.
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply10 May 2024, 13:57
Official
Hi Vurushca,
As previously confirmed, the member will be liable for the service/ This means that you will have to pay cash for services/items that are not part of scheme benefits.
The business of the Scheme is undertaking, in return for a premium or contribution, the liability associated with one or more of the following activities:
As previously confirmed, the member will be liable for the service/ This means that you will have to pay cash for services/items that are not part of scheme benefits.
The business of the Scheme is undertaking, in return for a premium or contribution, the liability associated with one or more of the following activities:
- Providing for the obtaining of any relevant health service;
- Granting assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; or
- Rendering a relevant health service, either by the medical scheme itself, or by any supplier or group or suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.
The benefits you pay are solely for medical expenses and are subject to the exclusions referred to in Annexure C of the registered Rules.
Best Regards
Bestmed Medical Scheme
VJ
Vurushca J's updateReviewer Update
11 May 2024, 09:36This is considered to be a health service. You guys refuse to pay for things, not once have you guys ever asked for the prescription from the optometrist. You just straight up said no, you are not paying for it. Where is the humanity in all this?
VJ
Vurushca J's update11 May 2024, 09:36
Reviewer Update
This is considered to be a health service. You guys refuse to pay for things, not once have you guys ever asked for the prescription from the optometrist. You just straight up said no, you are not paying for it. Where is the humanity in all this?
Bestmed Medical Scheme's replyOfficial
13 May 2024, 08:22Dear Vurushca,
We apologize for any inconvenience caused and understand your frustration.
We regret to inform you that the items in question are not covered under your scheme benefits. Even if you were to provide a prescription, there is no available benefit for these services. Attempting to process the claim from your annual savings would result in immediate rejection.
We regret to inform you that the items in question are not covered under your scheme benefits. Even if you were to provide a prescription, there is no available benefit for these services. Attempting to process the claim from your annual savings would result in immediate rejection.
You are, however, welcome to purchase these items privately.
Please consider this matter resolved, and we will not be providing further replies to this complaint.
Best Regards
Bestmed Medical Scheme
Bestmed Medical Scheme's reply13 May 2024, 08:22
Official
Dear Vurushca,
We apologize for any inconvenience caused and understand your frustration.
We regret to inform you that the items in question are not covered under your scheme benefits. Even if you were to provide a prescription, there is no available benefit for these services. Attempting to process the claim from your annual savings would result in immediate rejection.
We regret to inform you that the items in question are not covered under your scheme benefits. Even if you were to provide a prescription, there is no available benefit for these services. Attempting to process the claim from your annual savings would result in immediate rejection.
You are, however, welcome to purchase these items privately.
Please consider this matter resolved, and we will not be providing further replies to this complaint.
Best Regards
Bestmed Medical Scheme