Orthodontic authorisation

My daughter was sent for orthodontic work on her upper and lower teeth is May 2024. This is a 3 phase treatment. With the first orthodontic phase they firstly rejected the clain saying that I app**** for 2023 and not 2024, after a huge fight they corrected their mistake and paid part of the treatment. Now phase 1 for the upper braces are at the where phase 2 can begin. I sent the quote estimate to Gems on 28 Sept 2025. The request that all the images and measurements are sent through which was done. I get a reply requesting time for treatment and request to explain why there are already upper braces on the upper teeth. This was all stated on the quote, including the deducted amount for phase one (upper braces). After this they requested a statement with all the payments and payment dates. Everything was sent to them from her 1 appointment upto her last. Still no reply to my request. After numerous phone calls from myself and emails from the medical practice I get a response that my claim has been rejected. According to them my child's ICON score does not meet the criteria. When asked that her ICON score is they can not answer me, they are not willing to explain how they get this score. I have paid all the amounts to the orthodontist from Jan-Oct out of my own pocket because I know when the second phase starts there will be a large amount to be paid for the fitment of the lower braces. The lower braces needs to attach to the upper braces with elastics. I have been in Gems for several years but this is pathetic. I have spent more than 2 hours on the phone with them and each time it's a different story or excuse. This is not even a huge claim, R6900 to be precise because that is all that they pay for orthodontics per year.