AS
Andre S
1 reviews | Active since Sept 2023
22 Sept 2023, 12:03
VERY DISGRUNTLED AND POSSIBLY ON MY WAY TO HOSPITAL
My wife and I are both on chronic medication... or so I thought. I suffer from diabetes for more than 15 years. We were always at Bestmed. Accept for strips and needles Bestmed never put my medication on chronic, irrespective of various requests thereto and the submission of all documents requested. There are always excuses and promises to rectify the situation. Today I wnet to the pharmacy to retrieve my medication and guess what... sorry Sir your Acute benefits are depleted. It was therefore never rectified. As I sit here typing my glucose level is 26.2 and climbing (yes I do have a meter). I cannot afford the medicine due to Bestmed's ineptness, Whats worse (if it is indeed possible) is that my wife's medication is also suddenly on Acute although Bestmed informed her that it was rectified. The aforementioned is not only a serious breach of contract on Bestmed's side but also infers that Bestmed quite frankly does not care if you die. If you are searching for a medical aid, please take the above into consideration and if you do not agree with me, please read the hundreds of reviews that does.
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Replies (7)0
Replies (7)
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 10:19Dear Andre Swanepoel
Kindly note that the rejected medication is not loaded under chronic, as we have not yet received the prescription for it. Please forward the prescription to *** for review.
There was also an issue with the claim, the pharmacy claimed Ryzodeg Penfill 100U/ML with a quantity of 5 for a 20-day supply, but we approved Ryzodeg Flextouch 100IU/ML with a quantity of 5 for a 30-day supply.
Please note that Stresam 50mg is not a chronic medication, it is covered under the available acute medication benefits.
I've sent you chronic letters via email, so you can see what medications are loaded under chronic.
Regards
Nondumiso Letsoalo
Kindly note that the rejected medication is not loaded under chronic, as we have not yet received the prescription for it. Please forward the prescription to *** for review.
There was also an issue with the claim, the pharmacy claimed Ryzodeg Penfill 100U/ML with a quantity of 5 for a 20-day supply, but we approved Ryzodeg Flextouch 100IU/ML with a quantity of 5 for a 30-day supply.
Please note that Stresam 50mg is not a chronic medication, it is covered under the available acute medication benefits.
I've sent you chronic letters via email, so you can see what medications are loaded under chronic.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 10:19
Official
Dear Andre Swanepoel
Kindly note that the rejected medication is not loaded under chronic, as we have not yet received the prescription for it. Please forward the prescription to *** for review.
There was also an issue with the claim, the pharmacy claimed Ryzodeg Penfill 100U/ML with a quantity of 5 for a 20-day supply, but we approved Ryzodeg Flextouch 100IU/ML with a quantity of 5 for a 30-day supply.
Please note that Stresam 50mg is not a chronic medication, it is covered under the available acute medication benefits.
I've sent you chronic letters via email, so you can see what medications are loaded under chronic.
Regards
Nondumiso Letsoalo
Kindly note that the rejected medication is not loaded under chronic, as we have not yet received the prescription for it. Please forward the prescription to *** for review.
There was also an issue with the claim, the pharmacy claimed Ryzodeg Penfill 100U/ML with a quantity of 5 for a 20-day supply, but we approved Ryzodeg Flextouch 100IU/ML with a quantity of 5 for a 30-day supply.
Please note that Stresam 50mg is not a chronic medication, it is covered under the available acute medication benefits.
I've sent you chronic letters via email, so you can see what medications are loaded under chronic.
Regards
Nondumiso Letsoalo
AS
Andre S's updateReviewer Update
26 Sept 2023, 11:42Good day
My apologies to state that your reply does not compute.
I did not immediately accept my last prescription after I found that it was for some reason not covered under chronic
After various enquiries we found that for the past three prescriptions my medication was listed under my wife's date of birth. We are in the process of rectifying this with your company, specifically transferring it from acute to chronic (all necessary documents were forwarded). What is however worrying is that instead of my prescription then being rejected the following transpired:
a) you allowed my needles and test strips to be covered under chronic even though it reflected under the wrong individual's date of birth;
b) you allowed the dispensing of scheduled prescription medication to proceed to a person with a different date of birth; and
c) instead of refusing the medication you allowed it to be dispensed and charged it as acute.
In the above regard the HPCSA will in all likelihood not agree with this conduct.
After rectifying the date of birth my medication was collected as I obviously was in need of it. The pens for the same medication were unfortunately not available anymore accept for the refills that is not only cheaper but comes with a once off complimentary pen. These refills did go through under chronic as it is precisely the same medication (not generic) and same quantities. (you can even go Google it) If this is now queried then you would retract on allowing it under chronic that would also be a matter for the HPCSA.
HAD THE AUTHORIZATION AND RELEASE OF MY MEDICATION BEEN DEALT WITH CORRECTLY FROM THE START THE PRESENT PREDICAMENT WOULD NOT HAVE COME TO FRUITION.
My apologies to state that your reply does not compute.
I did not immediately accept my last prescription after I found that it was for some reason not covered under chronic
After various enquiries we found that for the past three prescriptions my medication was listed under my wife's date of birth. We are in the process of rectifying this with your company, specifically transferring it from acute to chronic (all necessary documents were forwarded). What is however worrying is that instead of my prescription then being rejected the following transpired:
a) you allowed my needles and test strips to be covered under chronic even though it reflected under the wrong individual's date of birth;
b) you allowed the dispensing of scheduled prescription medication to proceed to a person with a different date of birth; and
c) instead of refusing the medication you allowed it to be dispensed and charged it as acute.
In the above regard the HPCSA will in all likelihood not agree with this conduct.
After rectifying the date of birth my medication was collected as I obviously was in need of it. The pens for the same medication were unfortunately not available anymore accept for the refills that is not only cheaper but comes with a once off complimentary pen. These refills did go through under chronic as it is precisely the same medication (not generic) and same quantities. (you can even go Google it) If this is now queried then you would retract on allowing it under chronic that would also be a matter for the HPCSA.
HAD THE AUTHORIZATION AND RELEASE OF MY MEDICATION BEEN DEALT WITH CORRECTLY FROM THE START THE PRESENT PREDICAMENT WOULD NOT HAVE COME TO FRUITION.
AS
Andre S's update26 Sept 2023, 11:42
Reviewer Update
Good day
My apologies to state that your reply does not compute.
I did not immediately accept my last prescription after I found that it was for some reason not covered under chronic
After various enquiries we found that for the past three prescriptions my medication was listed under my wife's date of birth. We are in the process of rectifying this with your company, specifically transferring it from acute to chronic (all necessary documents were forwarded). What is however worrying is that instead of my prescription then being rejected the following transpired:
a) you allowed my needles and test strips to be covered under chronic even though it reflected under the wrong individual's date of birth;
b) you allowed the dispensing of scheduled prescription medication to proceed to a person with a different date of birth; and
c) instead of refusing the medication you allowed it to be dispensed and charged it as acute.
In the above regard the HPCSA will in all likelihood not agree with this conduct.
After rectifying the date of birth my medication was collected as I obviously was in need of it. The pens for the same medication were unfortunately not available anymore accept for the refills that is not only cheaper but comes with a once off complimentary pen. These refills did go through under chronic as it is precisely the same medication (not generic) and same quantities. (you can even go Google it) If this is now queried then you would retract on allowing it under chronic that would also be a matter for the HPCSA.
HAD THE AUTHORIZATION AND RELEASE OF MY MEDICATION BEEN DEALT WITH CORRECTLY FROM THE START THE PRESENT PREDICAMENT WOULD NOT HAVE COME TO FRUITION.
My apologies to state that your reply does not compute.
I did not immediately accept my last prescription after I found that it was for some reason not covered under chronic
After various enquiries we found that for the past three prescriptions my medication was listed under my wife's date of birth. We are in the process of rectifying this with your company, specifically transferring it from acute to chronic (all necessary documents were forwarded). What is however worrying is that instead of my prescription then being rejected the following transpired:
a) you allowed my needles and test strips to be covered under chronic even though it reflected under the wrong individual's date of birth;
b) you allowed the dispensing of scheduled prescription medication to proceed to a person with a different date of birth; and
c) instead of refusing the medication you allowed it to be dispensed and charged it as acute.
In the above regard the HPCSA will in all likelihood not agree with this conduct.
After rectifying the date of birth my medication was collected as I obviously was in need of it. The pens for the same medication were unfortunately not available anymore accept for the refills that is not only cheaper but comes with a once off complimentary pen. These refills did go through under chronic as it is precisely the same medication (not generic) and same quantities. (you can even go Google it) If this is now queried then you would retract on allowing it under chronic that would also be a matter for the HPCSA.
HAD THE AUTHORIZATION AND RELEASE OF MY MEDICATION BEEN DEALT WITH CORRECTLY FROM THE START THE PRESENT PREDICAMENT WOULD NOT HAVE COME TO FRUITION.
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 14:18Dear Andre Swanepoel
The pharmacy incorrectly claimed the needles and test strips under your wife. They were paid from acute medication benefits because there was no authorisation for her. We did not pay from chronic benefits.
We trust that the provider processes the claims according to the script, so if benefits are available, we cannot decline the claim; it will be paid from available benefits.
To correct this, the pharmacy needs to reverse the items incorrectly claimed under Mrs. Bester-Swanepoel and reprocess them under the correct dependant, which, in this case, is you. Once the reversal is done, we will credit the funds that were used back to acute medication benefits.
For the penfill, the pharmacy can't claim a different day of supply than what was approved. They must claim the quantity and day of supply we approved to be paid from chronic benefits. And we can only pay for medication and generics that we have approved under chronic.
Regards
Nondumiso Letsoalo
The pharmacy incorrectly claimed the needles and test strips under your wife. They were paid from acute medication benefits because there was no authorisation for her. We did not pay from chronic benefits.
We trust that the provider processes the claims according to the script, so if benefits are available, we cannot decline the claim; it will be paid from available benefits.
To correct this, the pharmacy needs to reverse the items incorrectly claimed under Mrs. Bester-Swanepoel and reprocess them under the correct dependant, which, in this case, is you. Once the reversal is done, we will credit the funds that were used back to acute medication benefits.
For the penfill, the pharmacy can't claim a different day of supply than what was approved. They must claim the quantity and day of supply we approved to be paid from chronic benefits. And we can only pay for medication and generics that we have approved under chronic.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 14:18
Official
Dear Andre Swanepoel
The pharmacy incorrectly claimed the needles and test strips under your wife. They were paid from acute medication benefits because there was no authorisation for her. We did not pay from chronic benefits.
We trust that the provider processes the claims according to the script, so if benefits are available, we cannot decline the claim; it will be paid from available benefits.
To correct this, the pharmacy needs to reverse the items incorrectly claimed under Mrs. Bester-Swanepoel and reprocess them under the correct dependant, which, in this case, is you. Once the reversal is done, we will credit the funds that were used back to acute medication benefits.
For the penfill, the pharmacy can't claim a different day of supply than what was approved. They must claim the quantity and day of supply we approved to be paid from chronic benefits. And we can only pay for medication and generics that we have approved under chronic.
Regards
Nondumiso Letsoalo
The pharmacy incorrectly claimed the needles and test strips under your wife. They were paid from acute medication benefits because there was no authorisation for her. We did not pay from chronic benefits.
We trust that the provider processes the claims according to the script, so if benefits are available, we cannot decline the claim; it will be paid from available benefits.
To correct this, the pharmacy needs to reverse the items incorrectly claimed under Mrs. Bester-Swanepoel and reprocess them under the correct dependant, which, in this case, is you. Once the reversal is done, we will credit the funds that were used back to acute medication benefits.
For the penfill, the pharmacy can't claim a different day of supply than what was approved. They must claim the quantity and day of supply we approved to be paid from chronic benefits. And we can only pay for medication and generics that we have approved under chronic.
Regards
Nondumiso Letsoalo
AS
Andre S's updateReviewer Update
26 Sept 2023, 15:27good day
The Ryzodec is the same medication. The only difference is that the one is a refill (penfill). Penfill is not a medication. The lesser quantity of Ryzodec
received was due to the unavailability of stock
The Ryzodec is the same medication. The only difference is that the one is a refill (penfill). Penfill is not a medication. The lesser quantity of Ryzodec
received was due to the unavailability of stock
AS
Andre S's update26 Sept 2023, 15:27
Reviewer Update
good day
The Ryzodec is the same medication. The only difference is that the one is a refill (penfill). Penfill is not a medication. The lesser quantity of Ryzodec
received was due to the unavailability of stock
The Ryzodec is the same medication. The only difference is that the one is a refill (penfill). Penfill is not a medication. The lesser quantity of Ryzodec
received was due to the unavailability of stock
AS
Andre S's updateReviewer Update
26 Sept 2023, 15:28Please as someone with the necessary knowledge of medicine to revert in future.
AS
Andre S's update26 Sept 2023, 15:28
Reviewer Update
Please as someone with the necessary knowledge of medicine to revert in future.
Bestmed Medical Scheme's replyOfficial
26 Sept 2023, 16:08Dear Andre Swanepoel
Your complaint has been forwarded to the medicine department to assist and provide feedback to you.
Regards
Nondumiso Letsoalo
Your complaint has been forwarded to the medicine department to assist and provide feedback to you.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply26 Sept 2023, 16:08
Official
Dear Andre Swanepoel
Your complaint has been forwarded to the medicine department to assist and provide feedback to you.
Regards
Nondumiso Letsoalo
Your complaint has been forwarded to the medicine department to assist and provide feedback to you.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's replyOfficial
27 Sept 2023, 09:03Dear Andre Swanepoel
Kindly note that your medication was reprocessed and approved for payment, except for Streams 50mg. As I explained in my previous response, it is not considered a chronic medication.
Once the medication claimed under your wife is reserved, we will credit the funds back to your acute benefits.
Regards
Nondumiso Letsoalo
Kindly note that your medication was reprocessed and approved for payment, except for Streams 50mg. As I explained in my previous response, it is not considered a chronic medication.
Once the medication claimed under your wife is reserved, we will credit the funds back to your acute benefits.
Regards
Nondumiso Letsoalo
Bestmed Medical Scheme's reply27 Sept 2023, 09:03
Official
Dear Andre Swanepoel
Kindly note that your medication was reprocessed and approved for payment, except for Streams 50mg. As I explained in my previous response, it is not considered a chronic medication.
Once the medication claimed under your wife is reserved, we will credit the funds back to your acute benefits.
Regards
Nondumiso Letsoalo
Kindly note that your medication was reprocessed and approved for payment, except for Streams 50mg. As I explained in my previous response, it is not considered a chronic medication.
Once the medication claimed under your wife is reserved, we will credit the funds back to your acute benefits.
Regards
Nondumiso Letsoalo