Poor Communication and No Transparency

I submitted a claim for emergency dental treatment, including the surgical removal of an impacted wisdom tooth, and paid the account myself. Platinum Health acknowledged receipt of my claim and supporting documents, but despite several follow-ups, I never received a written outcome, remittance advice, rejection letter, or explanation.

When I eventually called, I was verbally informed that the claim had been rejected, yet no reason was provided and no Scheme rule was cited. As a paying member, I expect transparency and proper communication. If a claim is rejected, members deserve a written explanation and details of the appeal process.

My biggest disappointment is not the claim itself, but the complete lack of accountability and communication. I have now escalated the matter formally and am considering taking it further with the Council for Medical Schemes if it remains unresolved.

Very disappointing experience.