What care is actually given? Guidelines vs rules

Have been messed around and gaslit constantly by *** regarding multiple autoimmune and dental issues. I was reccomended by their "clinical risk assessors" to get dentures at 38yo, which is highly against basic clinical care. But they claim that's all the public sector pays for, so that's all they'll pay for. *** can not even provide the qualifications of their clinical risk team. But have confirmed that there is ONE doctor (GP? They couldn't confirm) and a bunch of nurses. These are the people who make complex decisions about what they'll provide to specific member cases. Though their qualifications are unclear? Only one doctor? For an entire scheme? Not even a specialist physician on staff? Guess nurses are cheaper. No wonder people who need care aren't getting it. Even in private. Even. On the highest plan. And complex medical requests are denied. If this is one of the best ones, what does that say about South Africa?