Frustrated

Dear HelloPeter, I would just like to state my experience of a recent claim we were trying to submit, I don't know where I am going wrong... my wife needs to go for a operation on her knee and this was declined same day it was submitted, when we phoned to talk as to how to go forth, they could not help, they needed a motivational letter from the Specialist this was not given from Specialist nor the quote as our medical aid says this procedure is not covered under the PMB...how are we as a paying customer for years supposed to know about these? If we knew we would've upgraded our medical plan to a better option, but only to find out that can only do this in November months yearly as this is not a life changing situation....I do not understand why all insurance always look for a way not to help in other words not to pay... it has been a hassle and struggle to get another medical aid, we do however feel we would need to go to another doctor for their opinion...