Liberty Med Scheme Unstated Rejection

<p>I underwent a laser eye surgery on 27/05/2016. I paid upfront for the procedure an amount of R27 000. I susequently sent claims to my medical aid Liberty med aid- Saver Select option. The scheme refunded me only R1 785 of the total amount. In the claim process I was asked to obtain a motivational letter by the Optivest advisor Mandy Sithole from my doctor for consideration. Later a rejection was sent which stated the reason that the excimer laser is a scheme exclusion. I contacted Mandy earlier today on this just to highlight to ask and highlight to her that this exclusion is not explicitly stated on the medical aid documents. To which she rep**** the scheme does not have to write all exclusions in detail. She also mentioned that anyways the invoice would have been rejected as I did not request pre-authorisation within within 48 hrs. I was unaware and did not do that, and besides that was not the rejection reason, the reason was the exclusion of excimer laser. I would like further clarity on this, and to get assurity that my claim was assessed properly. And if something is not stated clearly as an exclusion then surely it means it is assessed on its merits, I sent doctor's motivation, was that looked at?</p>