R12,000 monthly premium

On the 6/7/2018 my daughter Lia Winterbach had a dental procedure done under general anesthetic at the Fuachard Day Clinic – she was 5 years old at the time. An authorization number was given before hand and MEDI HELP apparently refused to pay for the day clinic as she was 5 years and 9 months old and not just 5 years? I do not understand this statement AT ALL- you are not 6 untill your next actual birthday. The amount claimed was R18,374.25 and this was rejected as my daughter was 5 and 9 months at the time- Is the statement “under 5” meaning 4 years and 11 months and 29 days” or is it 5 years and under? This is nowhere stated in the brochure. It purely states “younger than 5 or <5 ”- is this 5 years and 1 day or 4 years old and below? Just like their policy states children will be covered <26, is this 26 years old and 6 months or you have to look for alternative cover BEFORE your 27th Birthday? This is not stipulated clear ANYWHERE. So if your dependant turns 26 tomorrow- they are NO LONGER covered with immediate effect? Or do you give grace WHILE being 26 and BEFORE their 27th birthday? We had to pay this amount cash which I think is totally absurd and unacceptable seeing that we pay a monthly contribution of R11,472 and been members of this medical aid for well over 10 years. We then had another procedure done yesterday 6/10/2020, Lia being 7 years old (older than 5) which we are liable for, we also did ask for an ex-gratia payment which was also very firmly rejected. This amount was for R11,248.57 which the dr also gave a motivation for which was also completely rejected. I understand the rejection as she now is 7 years old, however, we have been long standing paying clients and this treatment is just not how you treat your client fairly. And not by saying the patient is 5 years and 9 months? 5 years old is 5 years old, you only turn 6 on your next birthday! Medi help should reimburse us for the R18,300