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HJ
Helen J

1 reviews | Active since Jul 2021

05 Mar 2024, 18:41

Worst despicable medical aid

As I said previously there should be a minus or zero option. I, to this day, do not have authorisation for my operation despite almost 2 weeks ago sending the evidence it isn't a precondition (and having to cancel my scheduled operation) and I have even escalated my problem to the CEO who has ignored my emails. My foot continues to swell on a daily basis causing me huge health issues. They now ignoring every email I send!!!

Anyone looking at Bestmed, STAY AWAY!!!!! LOOK AT THE NUMBER OF MEMBERS THEY HAVE AND WHERE THEY STAND ON THE LADDER!!!! THAT SAYS IT ALL!!! NOTHING BUT **** FROM THEM. My son is an epileptic which is a life threatening disease and they refuse to pay for his medication or his ECG for 12 months, please note 12 months, as it is a precondition. Epilepsy is not a casual thing and they put a 12 month precondition on it.

Proves they don't review what is critical and what isn't they just set a blanket for take-on...and I now need an operation which isn't a pre condition and despite giving them the evidence it isn't (two weeks ago), I can't get authorization to go ahead.

Nobody must ever consider this as a medical aid as it isn't. There is no customer service and every staff member reads off a script and never tries to help you. If you want to move from Discovery, look at Bonnitas I only hear great things. When medical professionals speak badly of a medical aid, then you know Bestmed is the worst!!!!!!!!

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Replies (2)
Bestmed Medical Scheme
Bestmed Medical Scheme's reply06 Mar 2024, 11:04
Official
Dear Helen

Your hospital authorisation has been granted, and I have emailed you the authorisation letter.

Regards
Nondumiso
Bestmed Medical Scheme
Bestmed Medical Scheme's reply08 Mar 2024, 10:49
Official
Dear Helen, 
 
We are pleased to inform you that your inquiry has been resolved. Just to provide context to the delay surrounding your inquiry:
During November 2023 you requested authorization upon which the Scheme, in turn, requested specific information which was not received at that time. 
During February/March 2024, you again requested the same authorisation upon which the Scheme again requested specific information which again was not provided to the Scheme despite multiple attempts. The reluctance to share the information with the Scheme was the root cause for the delay in finalizing your authorisation request. 
As a responsible medical scheme, we have an obligation to all our members to protect their interests from undue risk. When considering an authorization request for our member, the Scheme must be able to substantiate that our member is indeed eligible to receive the authorization and that we have substantive reason for providing authorization. For this reason, the Scheme will at times and in certain cases request very specific information. In the event that the Scheme encounters reluctance from the requestor to provide such information, we must then either seek such information elsewhere, wait until we finally receive the requested specific information, or apply alternative risk management factors.
 
While the Scheme regrettably was not afforded your co-operation in this matter during the past 4-5 months, we are glad that our perseverance towards a solution for you to obtain your requested benefits could finally result in the Scheme providing you with authorization. 
Being a fairly new member with Bestmed Medical Scheme, we herewith also wish to remind you to fami****ise yourself with the Scheme Rules and the obligations imposed also upon you in terms of the Rules and the Medical Schemes Act, and to ensure you obtain maximum benefits from your chosen benefit option by making use of amongst others our Designated Service Providers, Preventative Benefits, and wellness program. Such information is obtainable through your Bestmed App, your online web-profile, or by contacting the Scheme if you are unsure of anything. 
 
Regards
Bestmed Medical Scheme